Behavioral, Developmental, and Emotional Issues Facing Children in Vietnam: Finding Hope and Support

Students unable or unwilling to follow classroom instructions and lessons; children verbally or physically abusing teachers, classmates, and family members; young people experiencing depression and even suicidal thoughts: talk with almost any family in Saigon and they will have a troubling story they’ve heard or witnessed firsthand.

Deficiencies in available assessment and treatment infrastructure compound the behavioral, developmental, and emotional issues observed among the city’s children. Thankfully, there is hope.

"Behavioral, developmental, and emotional issues among Saigon children are more prevalent than many realize," says Dr. Orly Dafni Attia, a pediatrician and early childhood development specialist with over 25 years of experience who has been serving medical clinics in Hanoi and Saigon since 2009.

The first step in getting help is recognizing the issue and enlisting relevant experts. Raffles Medical Group, the esteemed Singaporean healthcare provider that has operated in Vietnam since 1990, and its team of experienced professionals, including Dr. Orly, are just a call away. Unfortunately, several barriers frequently impede this first step. Dr. Orly notes that families and teachers may hesitate to act due to cultural norms or a lack of awareness about early signs to look for. Even if someone does recognize behavioral, developmental, or emotional issues needing expert intervention, evidence-based diagnosis and assessment might occur later than it should, or not at all. "Early and accurate diagnosis by a qualified professional is crucial," emphasizes Dr. Orly.

Dr. Orly Dafni Attia.

Dr. Orly collaborates with a team of skilled professionals at Raffles Medical along with external specialists trained to deliver comprehensive solutions using a team-based, end-to-end service delivery approach. This approach involves assessing client needs, providing direct interventions, as well as offering training and support for family members, home-based caregivers, teachers, and other professionals.

The first step for Dr. Orly is to conduct a formal and thorough evaluation. She spends time with the child and converses with their family and, when required, the educational institutions and teachers involved in the child's learning environment. As a Pediatric and Developmental Specialist, she has extensive experience in providing a detailed assessment of a child’s social, emotional, behavioral, and learning milestones and determining the necessary next steps.

In many cases, Dr. Orly designs and implements an appropriate personalized treatment plan. For medical issues, including illnesses and genetic syndromes, many treatments can be administered without leaving the city. Every course of action involves full transparency and collaboration with the families. Dr. Orly also encourages obtaining a second opinion and asking questions to ensure every family is confident and comfortable with the treatment plan.

While Saigon’s medical care has improved significantly in recent decades, there are still many areas where it lags behind international best practices. Dr. Orly explains that in countries with advanced systems of support, she would implement treatment plans with a team that might include a psychologist, psychiatrist, behaviorist, speech therapist, occupational therapist, and/or physiotherapist, as well as specialized schools to collaborate with. This is not the case in Vietnam, so in response, Raffles Medical has developed a network of proven and trusted, internationally trained, and experienced professionals representing these fields. If Dr. Orly recognizes a case beyond her scope of expertise, such as suspected Autism Spectrum Disorder (ASD), she reaches out to one of these specialists as part of a team-based approach. She cautions that because an increasing number of professionals claim to offer comprehensive services in this specialized field, it is essential for those seeking help to carefully verify the provider's experience and training. A key strength of Raffles Medical is its meticulously vetted network of well-trained professionals, with whom they have established proven and trusted, long-term partnerships.

Among Dr. Orly's many trusted contacts are Learning Strategies (LS), the International Center for Cognitive Development (ICCD), international schools' dedicated speech and occupational therapists, as well as Raffles Medical’s in-house psychologists and psychiatrists, and its strategic partner, The American International Hospital (AIH), known for providing comprehensive healthcare services. In Q4 of 2023, Raffles Medical Group entered into a strategic partnership and management agreement with the American International Hospital (AIH) in District 2 to further these efforts. 

For over 10 years, Raffles Medical has worked with Learning Strategies, an educational support organization which primarily supports individuals with autism, as well as those dealing with ADHD, addictions, depression, and eating disorders. Tony Louw, the Managing Director, describes the process when they assess a child suspected of being on the autism spectrum, whether the referral comes from a medical institution like Raffles Medical, a family, or a school.

“We personally meet with everyone who comes to the center, and during our initial meeting, the team interacts with the child to undertake an initial assessment of their needs and the child’s environmental situation and context. We examine key developmental areas, such as language skills, play skills, and social skills,” Tony explains. Following this, a thorough discussion is conducted with the parents in the family's native language to gather details about the child's progress at home and in school, and a complete history of the child's development at home and school. Based on this information, an individualized treatment plan is developed, which includes recommendations and measurable goals. A team of Learning Strategies therapists and a case manager are then assigned to implement the plan.

“Everything we do is play-based,” Tony says. “It’s designed to be enjoyable and motivating for the child, making sure they fully benefit from and enjoy their therapy.” He advises that if a child does not connect with their therapist, it's important to find a better fit. The program should feature clear, measurable objectives accessible to parents. Family involvement is crucial, and parents should be actively engaged, with opportunities to ask questions, including direct observation of the therapy sessions.

The relationship between Raffles Medical and its collaboration partners, such as Learning Strategies, is a two-way exchange. “Dr. Orly and I have been working together for many years, so we have developed a mutual understanding,” Tony explains. He elaborates that he often encounters patients who need expertise beyond his scope. For instance, if he suspects a medical or genetic issue underlying a developmental condition, he will refer them to qualified physicians such as Raffles Medical for specialized care.

A similar arrangement exists with other partners, including the International Center for Cognitive Development (ICCD). The center’s managing director, Dr. Azreal Jeffrey, a psychologist and education specialist from the United States, has collaborated with Dr. Orly for nearly a decade. “We have each other on speed dial,” he notes, highlighting their close partnership where they frequently co-manage a child’s treatment. They maintain constant communication to update each other on decisions and patient progress. Dr. Jeffrey points out that under-qualified physicians in Vietnam often over-medicate. To counteract this, he refers patients with emotional and behavioral disorders to Dr. Orly to ensure accurate medical diagnosis and responsible, effective prescriptions. “I’ve worked with many developmental pediatricians, and Dr. Orly is probably the best I know in any country, period,” he asserts. 

Dr. Jeffrey attributes his trust in Dr. Orly to her extensive experience, natural empathy, and cultural competency. Unlike in America, where a doctorate in psychology requires ten years of higher education, Vietnam licenses psychologists after only three years of undergraduate study. Thus, ICCD recruits professionals from abroad to ensure proper qualifications, which introduces challenges related to cultural competency. “You have to be able to work with the 140 different nationalities that we see, and each one has its own expectations,” Dr. Jeffrey explains. This cultural adaptability can complicate staffing since not all skilled professionals can adjust to the cultural aspects of work and life in Vietnam. Consequently, assessing cultural fit becomes part of the hiring process, and two-year contracts help provide consistency for patients, which is crucial for the child-psychologist relationship.

In addition to advising parents seeking help for a child with behavioral, developmental, and emotional issues to consider qualifications and reputation, Dr. Jeffry emphasizes the importance of following scientific principles. “For instance, a speech and language pathologist should meet with a student once a week and give homework. If they claim to need 15 to 20 hours a week, be very suspicious,” he warns. Frequent, long sessions indicate the professional might not be adhering to scientific standards and could be prioritizing billable hours over effective treatment.

While cost is a concern, Dr. Jeffrey warns against assuming more expensive care is better. Parents often want to spare no expense, which can lead to unnecessary or harmful services and treatments. “We’re about one-third the cost of Singapore and half the cost to Thailand,” he mentions, adding that families who leave ICCD for more expensive options in Vietnam often return, recognizing ICCD’s superior treatment effectiveness. He advises parents to prioritize a clinic’s reputation, qualifications, and willingness to involve families in the treatment process over cost when choosing care for their children.

Dr. Jeffrey also emphasizes the importance of parental involvement in the treatment program. He firmly believes that without the active participation of parents, the treatment’s effectiveness is significantly compromised. Consequently, he will not accept a child into his program unless the parents are fully committed to being involved. Moreover, Dr. Jeffrey insists on a single-provider approach for consistency and accuracy. “It takes the parents' cooperation and if they refuse to cooperate, then I say ‘I'm sorry that we can't take the case.’ And if they’re [currently] seeing someone who is detrimental to them and they want to see us at the same time, I tell them that they should pick the person that they're the most comfortable with and stick with them because they don't want to give mixed signals to the child.”

Any concerns regarding a child's health and development can be deeply troubling for parents. Early assessment and intervention with experienced professionals are crucial. When issues are identified and addressed promptly, the child has a better chance of catching up to their peers, while the family can develop strategies to support their continued success in mainstream school, independent living, and a fulfilling life. It’s important not only to seek help early but also to ensure that the right resources are used. Raffles Medical, with its extensive network of experts and collaborators, offers a beacon of hope for families in Saigon.