At present, I continue to treat patients in the pediatric departments of several hospitals three days a week. Among them, I see cases of colds and diarrhea which are common childhood illnesses, but children with developmental disorders, such as ADHD and autism, account for the largest number of patients.

Certain developmental disorders, including some cases of ADHD and autism, can be effectively treated with medication, but most cannot be treated with medication alone. That is why giving advice on the difficulties experienced in daily life at home and at school is also an important part of my work.

Many of the consultations concern entering school, in particular, choosing between special needs education and general education, followed by whether small classes would be better than the usual large classes.

In the case of the latter, the question is not really about the advantages of small classes over large ones, but whether it would be better to choose another school known for its small classes instead of attending the local school with large classes.

This question seems to be based on the common assumption that small classes can enable teachers to keep an eye on the whole class and provide individual instruction. This is the view also taken by specialists in the literature on developmental disabilities. Moreover, the primary reason given for choosing special needs education over mainstream education for children with developmental disabilities is the smaller number of students which means more attentive instruction.

I am always a bit skeptical about this claim. In response to the above question, I often answer that large classes would be better. There are several reasons.

First, in large classes, the children come into contact with a wide range of diversity. Although such classes will include children with strong personalities that other children will find stressful, they are also likely to include children with high communication skills. Children learn language, including expressions that parents and teachers do not use, and the basics of human relationships through contact with other children in the class. From their classmates and peer groups, they learn expressions and slang that parents and teachers do not use as well as local rules of the group. Parents and teachers may consider such language strange, but using it within their group is a sign of affiliation.

The second reason is the flipside to the common assumption of small classes mentioned above; in large classes, there is more time free from the direct supervision of the teacher. The relationship between the teacher and students tends to be a hierarchical one, and most of the communication is one-way. For whatever reason, those children who do not behave as the teacher expects begin to feel much stress. Teachers are also individuals, like the other students. Just as there are some students who do not get along with everyone in the class, there are students and teachers who do not have a good relationship. Among some of the children I treat, some are troubled by relationship problems with the teacher, not inappropriate behavior on their part. In small classes, a deteriorating relationship between the teacher and students can be disastrous. In large classes, this risk decreases.

The third reason is that when there is a student experiencing problems, empathetic children and teachers may work together to respond to the student. When there is a student who can't communicate with the teacher, there are children who understand the student's feelings far better than the teachers and serve as an intermediary. Among the children I see, there are children who are supported by such empathetic children. Mothers often tell me that their child is helped by other children.

The idea that smaller classes are better than large ones seems to have been created from the perspective of adults (teachers), not from the perspective of children. This view may be justified by the responsibility to appreciate each child's individuality in the class and perceive any problem areas, but the classroom is not simply a site for the student-teacher relationship. If we consider it as a place where children can communicate and get involved with different friends, large classes are certainly better than smaller classes in some respects.