Mrs Latal, are all children today actually disturbed?

Bea Latal's office is located at the foot of the Zürichberg, not far from the children's hospital. It is tidy and uncluttered, with a red and blue «Gampiross» next to the round meeting table. The lively researcher appears confident and relaxed and speaks with great commitment.
Mrs Latal, some people say that too few children with developmental disorders receive help. At the same time, however, we also hear that some children today are too quickly pathologised and pigeonholed as «not normal». How does that go together?
That's true - both occur. We see around 2,500 children and young people with developmental and behavioural problems at the Children's Hospital every year. Some of these children are rightly sent to us because they are suffering from serious difficulties. We then ask ourselves why they have these problems and what the causes are. We clarify these children comprehensively. However, we also see parents who are very unsettled because their pubescent son is rebelling, their two-and-a-half-year-old daughter is displaying pronounced defiant behaviour or is biting other children at nursery. However, these are often behaviours that are part of child development in certain phases and are «normal». There are therefore behaviours that many children display during certain developmental phases, but to varying degrees and without being considered a disorder. These include separation anxiety, difficulty falling asleep and shyness.

«Many problems are part of the development phase and are therefore normal.»

Bea Latal

Are there also children who don't receive any help even though they need it?

That is a difficult question. It can happen that the cause of a certain behaviour is not recognised for a long time and therefore specific help is only offered at a late stage. Here's an example: A soon-to-be ten-year-old girl from a migrant background with language difficulties and behavioural problems is referred to us. We were repeatedly told that the child's problems were due to her bilingualism. In the end, the girl was examined and it turned out that she had a serious speech disorder that required therapy. So the problems are not simply because the girl is growing up speaking a different language at home. Of course, you then ask yourself: how could these difficulties have gone unrecognised for so long? Early recognition of developmental disorders in children can improve the course of the disease or at least have a positive influence. Another example is autistic disorder. If the problems are recognised early, treatment can also be started early.
Has it become more difficult for children and young people to grow up today compared to the past 20 years?
There has been a change. The focus is more on children. The child is something special. That's a good thing, but it also has its downsides, because parents are under a lot of pressure to prepare their children for society in the best possible way. The performance principle takes centre stage and expectations of children are often very high. Parents are afraid that their children will not be able to cope with the demands of modern life.
Where do the high parental expectations of children come from?

While previous generations were still lulled into a sense of security that their children would one day be better off than they were, this is no longer necessarily the case today. As a result, parents are under pressure and pass this on. Parents want their children to gain and absorb as much knowledge as possible and attend the best schools in order to be optimally equipped for life. It would be much more important to let children experience what they are good at, what strengths and resources they have. Because we get through life well with our strengths!

How do young people deal with this pressure to perform and parental expectations?
I recognise that many young people have great potential. However, this can develop much better if we take them seriously and are prepared to enter into a real relationship with them. Teenagers are not indifferent to their parents and teachers. We should try to see young people as partners and treat them as equals. If you really engage with them by listening to them, it is often easier to deal with them.
And what if a teenager defies their parents?

It's part of puberty to rebel, but no teenager wants everyone to turn their back on them. Even if their peers become more important to them, they are not indifferent to their parents. They want to know what they think. This means that parents should set boundaries; as a basis for negotiating with young people, so to speak.
What if a 16-year-old wants to drop out of school?

This is indeed a very difficult situation for everyone. But you can no longer force a young person of this age to continue attending school. Even if it is very demanding for parents to put up with this, it means above all sticking with it and looking with the young person to see what alternatives there are, what they want and what they can do. In other words, empathising with the teenager and asking: What does he need now? This often requires good nerves from parents, but it's worth not giving up. Because teenagers also realise that they are being taken seriously. Seeking professional support often brings relief in such situations and can be very helpful for everyone.

«Parents are under pressure to prepare their child optimally for the future.»

Bea Latal

It is often difficult to accept that your child is not going the way you imagined.
That's true. But not every child is a high-flyer. However, many parents don't want to admit this. That doesn't help anyone. The young person does not feel accepted and the parents have false expectations, which can lead to a weakening of self-confidence for children and young people over a longer period of time. For example, if parents who are both academics expect their son or daughter to complete a baccalaureate and go to university, but the young person is unable or unwilling to do so for various reasons, this often leads to great tension. Ultimately, parents should try to support the young person's strengths and guide them in their educational and professional choices. This may be a different - but much better - path for the child than their own.
So you are appealing to parental tolerance.

Yes - and I would like to go even further: It would be nice if society as a whole were more tolerant towards children and young people! To give just one example, this includes understanding that almost every child goes through a phase of defiance. A babbling two-year-old on the tram or in the supermarket is not «badly behaved». It's just discovering and testing its will. That's not a bad or evil thing. However, they need parents who will stand by them during this phase, who will practically go through it with them. Contemptuous looks and reproaches from a society that has no understanding certainly don't help. Instead, it is important that we have a fundamental understanding of child development.
You are calling for parents to be better informed about the development of children and young people.
Yes, and we should really try to understand children. If a five-year-old is afraid of being separated from his mum at his birthday party, it doesn't help if everyone talks to him and tells him to go and get his piece of cake on his own. Of course, there are children who really do have a mental disorder. An anxiety disorder, for example, that prevents them from attending school. Such a child needs help and psychotherapeutic treatment. However, this is not the same as a child in first grade who is still shy at the beginning and therefore needs their mother or father to accompany them in the morning. Instead of the school saying: «It'll come, we'll provide this support», the child is prematurely pathologised. In such situations, we have unfortunately often lost our common sense. If we had more understanding of how diverse human behaviour is, the stresses and strains that families experience due to children who deviate slightly from the norm would certainly be less.

Children develop very differently. But how should parents decide what is still «normal» and what is not?
It is often a question of gradual differences. Not like a broken leg, where the diagnosis is clear. When children suffer, their problems manifest themselves in their behaviour or in psychosomatic symptoms such as headaches or stomach aches. Then it is important to find out what is behind it. For example: children with hyperactivity. It would be a mistake to label every hyperactive child with the diagnosis ADHD. ADHD is characterised by attention deficit disorder, hyperactivity and impulsivity. However, these symptoms must persist for several months and have already appeared in early childhood and affect more than one area of life. It is therefore always necessary to look at how, when and where the behavioural problems manifest themselves. Is the child only hyperactive when it is overwhelmed? Or is it usually better at school than at home? In around a third of referrals to our department, the question arises as to whether the child in question has ADHD. If these children are then thoroughly investigated, the diagnosis can only really be made reliably in some cases. For example, hyperactivity is often caused by a partial performance disorder such as dyslexia or a speech disorder. If these difficulties are then treated, the hyperactivity usually also improves.
What can therapies ideally achieve?

Therapy should ensure that the child is picked up where it is in its development and learns to have positive experiences, which in turn leads to a sense of achievement and motivation. However, a child with motor deficits who attends occupational therapy will not become a motoric high-flyer. But they will learn, for example, how to deal with their insecurities differently in the playground. And the parents also learn how they can deal with the child's difficulties. The starting point is always the child: What are their needs, what are their strengths, what do they need? This is why it is so important to involve the parents and create a good relationship of trust with them: after all, everyone wants the best for the child.

About the person

Prof. Dr Bea Latal heads the Developmental Paediatrics Department at Zurich Children's Hospital together with Prof. Oskar Jenni. Children with developmental and behavioural abnormalities are assessed, advised and supported there. The 50-year-old paediatrician is married and the mother of two sons (aged 15 and 17).

• Children's Hospital Zurich - Developmental Paediatrics
• Children's Hospital Zurich - Research Developmental Paediatrics