When does my child need therapy?

When the teacher suggests therapy, parents are often unsure and ask themselves: Does the child really need this support? Won't the problem grow out of itself?

Peter Lienhard, an expert in special education at the Intercantonal University for Special Needs Education, says: «Therapy is sensible and necessary if the child cannot realise their potential without this support and is therefore hindered in their education and development.» However, it is always important to ask what the goal of therapy is. This is the only way to check after a certain period of time - six months, for example - whether the measure was useful and what effects it had.

Is such support appropriate at kindergarten age? According to Peter Lienhard, this is at least negotiable: «With children of this age, it often makes sense not to immediately start the support machinery when certain abnormalities occur. A lot can happen at this stage of development.»

Psychomotor therapy

Psychomotor therapy has been widely used in Switzerland for many years. However, both the therapy and the children receiving therapy have changed significantly in recent years.

In the past, psychomotor therapy was mainly used for children with motor difficulties. Today, it is often children with social or emotional problems. For example, they find it difficult to integrate themselves into a group or to regulate feelings such as fear, anger or frustration. They also often show a combination of motor and socio-emotional problems," explains Dr Irene Kranz, lecturer on the psychomotor therapy course at the Intercantonal University for Special Needs Education in Zurich. For this reason, the therapeutic repertoire has also changed. In the past, therapy mainly comprised play and movement activities, but therapeutic role play is now also an important tool. This allows children to express their fears, anger, frustration or sadness in a playful way. In role play, the child can freely enact their personal story. This enables them to communicate stressful experiences symbolically instead of talking about them.

Take Eleni, for example. She suffers from severe anxiety, has little confidence and avoids unfamiliar situations. She hardly takes part in lessons and usually plays on her own during the break. She struggles with the new demands and the new environment. In gym class, she suffers from a fear of heights and avoids all climbing equipment.

Eleni's father was also anxious and reserved as a child, but over time he developed strategies for dealing with his fears and tried to support his daughter in overcoming her fears. Studies have shown that it is very important for the success of the therapy to involve the family and the school environment.

In the course of the therapy, confidence in one's own abilities and self-confidence is strengthened.

In psychomotor therapy, Eleni can learn about her strengths and weaknesses and become more courageous. She experiences herself as big, strong and powerful in self-enacted role-playing games. She likes to slip into the role of a brave tiger and fight other animals. She also dares to climb up the wall bars and attack her victims from a height. The therapist is usually assigned the role of a fearful animal. This gives her the opportunity to act out her fears and feelings of failure. This allows Eleni to make contact with her own feelings and learn new ways of dealing with them. As the therapy progresses, she gains more and more confidence in her abilities and her self-confidence is strengthened.

Studies clearly show that psychomotor therapy works on both a motor and socio-emotional level. Eleni is increasingly able to overcome her fears through playful processing. She is developing a positive self-image and is becoming more and more confident.

Her teacher reported that Eleni now plays with the other children more often, talks more in class and has become braver in gymnastics. Eleni will also benefit from her father's childhood experiences - and may one day be able to climb all the way up the wall bars.

Speech therapy

Speech therapy involves the assessment, therapy and counselling of children and young people with deficits in spoken and written language and voice. The aim is to improve communication skills in everyday life. However, language has to develop and it takes time for children to master and understand language with confidence.

Sometimes they encounter problems that they cannot overcome on their own. In this case, a consultation with a speech therapist is recommended. A speech therapy consultation is useful if the child speaks little or very little, has difficulty understanding both their mother tongue and German or is not understood well enough, if they cannot find familiar words or form sounds, has a lisp, stutters or a constantly hoarse voice.

A child might say «plumb» instead of «red» or «cup» instead of «till». What still seems cute to a three-year-old can be a hindrance in kindergarten - other children can't understand it or even mock it. So the question is: when is support needed? «Because children learn to speak at such different speeds, it is often not easy for parents to judge whether their child is speaking at an age-appropriate level,» says German paediatrician Herbert Renz-Polster. «Not every abnormality is immediately a disorder and needs to be treated.» However, if parents are worried because their five-year-old child is barely expressing themselves clearly, experts advise having the causes clarified.

In the first and second year of kindergarten, there is a series of speech therapy assessments - with the aim of recognising early enough where there is a need for action. A check-up then takes place in the first class at the latest. Five-year-old Louis, for example, goes to the speech therapist once a week to practise his «sh». He uses games, memory games, puzzles and other things to practise and consolidate the sibilant sound and, where possible, practises it at home with his parents. He enjoys the game ideas. The therapy ends after six months.

Herbert Renz-Polster also gives a tip for practising at home: if a child always says «baptise» instead of «buy» or «cake» instead of «tuchen», for example, it is of little use to have the child recite these individual words over and over again. «It's better to incorporate this term into a sentence or a story, to repeat it correctly over and over again and to look the child in the eye in order to build emotional closeness,» says Renz-Polster.

«A kindergarten child with a slight lisp is not at an immediate educational disadvantage.»

Curative education professor Peter Lienhard.

However, not every speech delay requires therapy, explains curative education professor Peter Lienhard. «A kindergarten child who has a slight lisp, i.e. bangs their tongue against their teeth when pronouncing an «S», is not at an immediate educational disadvantage. You can usually wait and see if it goes away.» If not, a speech therapy sequence can always be added.

Occupational therapy

Recently, a survey caused a stir, according to which only half of four-and-a-half to five-and-a-half-year-olds could dress themselves alone and only around 20 per cent could tie a bow. The co-author of the survey, paediatrician Rupert Dernick, sees the reason for the lack of dexterity not in the children, but in their environment. «Parents take too much from them.» Even when it comes to everyday tasks such as setting or clearing the table. It is true that most parents in the study of 500 children stated that their children had mastered simple tasks such as setting cutlery or drying plastic cups. However, only one in five children actually carried out these activities more often. «As a result, many children miss out on the opportunity to improve their skills through practice.»

The consequences are particularly evident in boys, says Dernick. «Occupational therapy is now prescribed for 20 per cent of five to six-year-old boys.» In Germany, too, it is assumed that one in three children will receive special support during their school career. Occupational therapy is one form of such support. It aims to challenge children in their development, independence and ability to act. It is based on the assumption that «being active» is a basic human need.

Occupational therapy is intended for children who lag behind their peers socially, cognitively or in their motor skills. For example, children who have problems driving a scooter, climbing stairs, tying their shoes or cutting out or painting small objects. Or who cannot adequately process what they hear, see, smell or taste.

There are many different reasons for seeking occupational therapy. Difficulties that are noticeable as perceptual or behavioural disorders can be due to organic or psychological causes such as birth trauma, deformities or progressive illnesses. Improving body coordination and familiarising children with their own abilities and limits should strengthen their self-confidence and increase their communication skills. Parents can support occupational therapy by doing the exercises or playing games with their child at home.

What parents can do

You help your child if you:

• Ermutigen und loben statt kritisieren.

• Akzeptieren statt vergleichen.

• Das Wort selber richtig wiederholen, statt es vom Kind «richtig sagen» zu lassen.
• Zeit lassen statt drängen.
• Zuhören, aussprechen lassen und nachfragen, statt ins Wort zu fallen. Gerade ein Kind, das Sprachprobleme hat, ist besonders darauf angewiesen, nicht unter Druck gesetzt zu werden.
• Miteinander spielen und sprechen, statt üben.
• Klar und einfach sprechen (nicht zu viel auf einmal).
• Zuhören, was das Kind zu sagen hat, statt auf Sprechfehler achten.
• Es erzählen lassen, ohne es immer zu korrigieren.
• Gewicht darauf legen, was das Kind Ihnen mitteilen möchte, und nicht wie es dies tut. Besser zusammen lachen als alles richtig machen!

Therapy mania in Swiss schools?

Paediatrician Oskar Jenni made headlines in November 2014 when he criticised the «therapy mania» at Zurich schools in an interview with the Tages-Anzeiger newspaper. The head of the Department of Developmental Paediatrics at Zurich Children's Hospital explained that it was nonsensical that one in three children received one or more low-threshold remedial therapies during their school years. It was unacceptable that so many children did not fulfil the standard expectations. Jenni criticised the system rather than the therapies. «If a child stands out, specialists, teachers and parents decide on a measure in a dialogue. And then everyone is happy because action is taken. The risk of misjudgement and stigmatisation of children is high.» At the age of four to six, however, the developmental differences in terms of language, motor skills, attention and behaviour control are naturally very large.

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