«Children need our confidence»

Mr Di Gallo, what problems do children and young people come to you with?

There is a wide range of mental disorders. Put simply, we differentiate between internalising, inward-looking illnesses such as depression or anxiety disorders, from which sufferers often suffer in silence, and externalising, outward-looking disorders such as ADHD, which manifest themselves through hyperactivity, impulsivity, aggressive or refusing behaviour. There are also disorders to which no one category 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.

What do you deal with most often?

With anxiety disorders, depression and ADHD. Each disorder is associated with different manifestations. For example, anxiety disorders can manifest themselves in separation anxiety and night terrors, as is often the case with small children, or in panic attacks and phobias. Depression is more common in adolescents, but can also occur in childhood.

Children often do not show classic symptoms such as listlessness or sadness, but react more subtly, for example with a reluctance to play or withdrawal, which makes the diagnosis challenging. A large part of our work also concerns psychosomatic disorders that occur when children are under a lot of emotional stress. Psychological reactions then become visible through physical symptoms such as headaches, weakness, sleep problems or eating disorders.

Early childhood experiences have a major influence on how we deal with stress later on.

You have been researching and treating mental illnesses for over 20 years. Are children more susceptible to them today?

There is no evidence that mental health problems have increased among them. Studies in recent decades suggest that around 20 per cent of all children and adolescents exhibit mental health problems within a year, with at least one disorder requiring treatment in around half of these cases. These figures are relatively stable.

The use of counselling, diagnostics and treatment has increased. This has to do with the fact that we now deal with mental illnesses more openly and are more sensitised to them. In addition, diagnostics have been refined and the diagnostic criteria for some illnesses have been expanded: when I was still a student, one in 1000 people were diagnosed with autism - today it is one in 80 to 100 people.

So there are more diagnoses, not more patients. This raises the question of what so-called fashion diagnoses are all about.

The aim of refined diagnostics is not to make people ill, but to provide more targeted support. Let's stay with the example of autism. Today, we talk about autism spectrum disorders because we know that the condition encompasses a range of developmental disorders that have similar symptoms but differ greatly in their severity. Today, we can also medically classify less obvious symptoms and help those affected who would previously have been labelled as odd. The same applies to other complex disorders such as ADHD.

Some people take a critical view of the fact that children who used to be considered lively are now diagnosed as such.

I agree with you: vivacity is not an illness. But it was also often penalised in the past, especially at school - with detention, punitive tasks and constant reproaches. At some point, a child draws the conclusion that they are inadequate. In this context, a diagnosis is relieving because you can categorise things and, above all, support the child.

However, the diagnosis of ADHD requires careful clarification. Unfortunately, this is not guaranteed everywhere. There are children with a diagnosis who do not have a disorder - and those who need help but remain unrecognised.

Parents find it difficult to judge where mood swings end and a mental disorder begins. When should they be alert?

It is important to keep an eye on the duration and severity of a problem. For example, many children develop night terrors in the course of their development, which is nothing to worry about. However, if the anxiety is so severe that it lasts for several weeks and prevents the child from sleeping, parents should seek help. Professional support is indicated if a problem or behaviour affects the child's everyday life in the long term - so that the child avoids, neglects or is excluded from age-appropriate activities such as school, hobbies or games with peers.

What risk factors jeopardise healthy mental development?

Firstly, there are the genes. You don't inherit a depression or anxiety disorder one-to-one, but you may inherit a predisposition to it. However, 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.

80 per cent of young people suffering from stress say that they put themselves under pressure.

Overall, early childhood experiences have a major influence on how we deal with stress later on. The first year of life in particular is of immense importance. During this phase, a child is particularly dependent on its needs for food, physical closeness and emotional affection being reliably met. Later on, severe conflicts with peers, parental separation or serious losses are factors that can favour a mental disorder.

What about stress? In a Swiss study, half of the young people surveyed stated that stress and excessive demands were part of their everyday lives.

It is interesting to note that the respondents did not feel under pressure from parents, teachers or vocational trainers - 80 per cent of the young people suffering from stress said that it was the high demands on themselves that were causing them problems and emphasised a lack of time and fear of the future.

What role does our education system play in this context?

It has become more permeable: You can always move up a level, get even better qualifications. That's an opportunity, but it comes with the risk of being overwhelmed. In the past, an apprenticeship was associated with the prospect of a permanent place in society. Today, it is important not to stand still. This can create pressure: where there is the lure of advancement, there is also the threat of falling, feelings of inadequacy and self-doubt.

Has growing up become more difficult?

Every generation faces new challenges. However, the frequency and speed of change has increased over the last 20 years - and with it the risk of uncertainty and identity crises. The variety of options as to who and how we want to be is immense.

This is desirable in principle, but also a challenge for young people, especially as there are more and more channels to use. Whether on WhatsApp or LinkedIn, in the classroom or on Instagram, you have to adapt your role. The majority of young people master this task with ease. For the more vulnerable 10 to 20 per cent that we talked about at the beginning, it can lead to excessive demands and psychological suffering. We are also noticing this: personality disorders that can be traced back to serious problems with identity development are on the rise.

What is the coronavirus crisis doing to children and young people?

Since last autumn, we have recorded up to a third more enquiries for inpatient and outpatient treatment. We are seeing an increase in aggressive behaviour and concentration problems among children, while the rise in depressive disorders and psychosomatic complaints among adolescents is striking. A year and a half of uncertainty can weigh heavily in a young life - much more heavily than for us adults, for whom the past few months are a small fraction of our lives.

Children need reliable boundaries.

Who is currently particularly at risk of developing mental health problems?

These are particularly children and young people from socially disadvantaged families with a low level of education and cramped living conditions. A good family climate, on the other hand, is one of the most important protective factors.

In general: How can parents strengthen their child?

By having confidence that they will cope well with their development and the challenges of our society. Because, as I said, the vast majority of children and young people manage to do this without any major problems. Children need our confidence and reliable boundaries. And they depend on adults who accept them for who they are. For parents, this means developing a sense of their child's personal requirements - and orienting themselves towards these instead of trying to mould them according to their own expectations.