9 questions about the child's psyche
1 What types of mental illness are there?
We distinguish between internalising disorders such as depression or anxiety disorders, from which the majority of sufferers suffer in silence, and externalising disorders such as ADHD, which manifest themselves through hyperactivity, impulsivity, aggressive or refusing behaviour. There are also cases in which neither of the two categories clearly applies because those affected direct their coping strategies both inwards and outwards. This can be the case with obsessive-compulsive or addictive disorders, for example. Girls are predominantly affected by inward-looking disorders, boys by externalising disorders.
Alain Di Gallo, Chief Physician of the Clinic for Children and Adolescents at the University Psychiatric Clinics Basel
2 Which risk factors jeopardise healthy mental development?
Firstly, there are the genes. You don't inherit depression or an anxiety disorder one-to-one, but you may pass on the predisposition to it. Behavioural role models also play a role: a father with an anxiety disorder does not simply pass on his genetic anxiety to his child, but shapes it with his presumably rather anxious behaviour as a role model.
Overall, early childhood experiences have a major influence on how we deal with stress later on. The first year of life is of immense importance in this respect. During this phase, a child is particularly dependent on its needs for food, warmth and emotional closeness being reliably met. Later on, family conflicts, parental separation, loss or stress such as bullying are factors that can favour and trigger a mental disorder.
Alain Di Gallo
3. how many children and young people suffer from mental illness?
Long-term studies show that around 20 per cent of all children and adolescents have mental health problems, with at least one disorder requiring treatment in around half of all cases. These figures have remained relatively constant over decades. During the coronavirus pandemic, however, the proportion has risen to 30 per cent. A higher uptake of diagnostics and counselling was already apparent beforehand, namely since around 2010.
Oliver Bilke-Hentsch, Head Physician at the Child and Adolescent Psychiatric Service of Lucerne Psychiatry
4 There are more and more psychiatric diagnoses. Are we pathologising children?
When I was a student, 1 in 1000 people were diagnosed with autism. Today, 1 in 80 to 100 people are affected. We talk about autism spectrum disorders because we know that the condition encompasses a range of developmental disorders that have similar neurobiological causes but differ greatly in their severity. Some sufferers are unable to speak, while others have very good language skills.
More sophisticated diagnostics make it possible to medically classify even less obvious symptoms and help sufferers who would previously have been labelled as odd. The same applies to disorders such as ADHD. It is not a question of talking children into being ill, they should receive adequate support. However, a diagnosis of ADHD requires careful assessment. Unfortunately, this is not guaranteed everywhere. Accordingly, there are children with a diagnosis who do not have a disorder at all and those who need help but fall through the cracks.
Alain Di Gallo
5 Why are so many young women in therapeutic treatment?
Female puberty begins earlier than male puberty. It brings with it major hormonal changes and considerable changes in appearance: up to 40 per cent more body fat is stored in a short period of time, and fat is not considered attractive in our society. Some girls are not yet cognitively developed enough to accept these changes: They are overwhelmed.
Unhealthy role models and constant comparison with others can lead to a downward spiral for girls.
Dagmar Pauli, Chief Physician
Girls generally have a more critical self-image. This is exacerbated by social media, where they spend more time than boys. Unhealthy role models and constant comparison with others can lead to a downward spiral, while unfavourable problem-solving strategies - such as self-harm or dieting - are also common and inspire imitation. Finally, girls are more often under pressure to perform because they have higher expectations of themselves, for example at school, where boys are more likely to be satisfied.
Dagmar Pauli, Chief Physician and Deputy Director of the Department of Child and Adolescent Psychiatry at the Psychiatric University Hospital Zurich
6. do young men have fewer mental health problems?
This cannot be assumed - we simply see fewer of them in consultation hours. Young women are more likely to be suicidal, but the number of completed suicides is higher among young men. We know that young women are more likely to seek help. Reaching troubled young men is a challenge. There is often a high risk that they will withdraw into virtual worlds, immerse themselves in gaming, only find reassurance there and become lonely in the long term.
Boys are brought up differently to girls. We need to counteract this so that something changes. Starting with talking to boys about their feelings at an early age and supporting them in learning to express and name them. And that we - fathers in particular - don't withhold our own emotions from them, but set an example of how to deal constructively with difficult feelings by talking about them and seeking help.
Dagmar Pauli
7 How do parents recognise whether their child has mood swings that will pass or whether a mental disorder is developing?
Parents should take a look if their child begins to withdraw noticeably, develops anxiety, neglects things they used to enjoy doing or suffers from sleep disorders. It depends on the duration and extent of the problem. If a teenager has a bad day from time to time and is temporarily not in the mood for social interaction, this is no cause for concern.
If the social withdrawal is so severe that young people avoid friends, hobbies or even school for a longer period of time, parents should sensitively address the issue and seek help.
Eveline von Arx, psychologist
However, if the social withdrawal is so severe that young people avoid friends, hobbies or even school for a longer period of time, and if anxiety is added to this, parents should address the issue sensitively and seek help. As a first step, low-threshold counselling services such as an appointment with youth or educational counselling can help.
Eveline von Arx, psychologist and psychological counsellor for students at KV Zurich and at the Gymnasium und Institut Unterstrass, Zurich
8. there is legitimate cause for concern, but the child refuses to talk. What now?
Parents should then not psychologise, but be very direct, clearly taking on the role of those who are responsible for the child and their health: «We see that you are withdrawing more and more and we are worried. In our family, we look out for each other and don't allow anyone to stop participating in life.»
I can't assume that my child will react with understanding, but it is my job to address the problem and show them possible ways out. It's important to make it clear: «This is an offer - if you don't take it up or it's not enough, I will take responsibility and register us with the youth counselling centre or psychotherapy.»
Simone Munsch, Professor of Clinical Psychology and Psychotherapy, Head of the Psychotherapeutic Practice Centre at the University of Freiburg
9. how can parents promote healthy mental development?
Knowledge about emotions plays a key role here. A child must first learn the ability to understand, name and categorise their own feelings. Parents can help them do this by mirroring and verbalising their emotions. Their ability to respond sensitively to the child's needs plays a central role in this learning process.
Children need opportunities to experience and learn to cope with negative feelings.
Simone Munsch, Professor of Clinical Psychology and Psychotherapy
However, this does not mean sparing the child negative emotions, but rather giving them the support they need to learn to deal with them. Children need opportunities to experience negative feelings and learn to cope with them. In such moments of frustration, parents should limit themselves to signalling to the child that they are there - and that they are confident that things will get better. If frustration tolerance and dealing with emotions are well developed, this is a protective factor for the psyche.
Simone Munsch
