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Child Science Exchange Program in East Asia 1: Children's Social Development and Deficits

Characteristics of the children who have ADHD

Today I'd like to talk about ADHD, high functioning autism, and Asperger syndrome.

ADHD, as written here, stands for Attention Deficit Hyperactivity Disorder.

It has been well known in Japan since its diagnostic criteria were specified in 1994. Perhaps circumstances are different in China, but in Japan, ADHD has attracted the considerable attention of physicians because they have found certain medication to be significantly effective for children with ADHD.

Diagnostic criteria for ADHD include 9 symptoms for each type and there are 18 behavioral characteristics in total. Diagnosis of ADHD requires at least 6 of the 9 symptoms. Inattentive symptoms are, for example, difficulty concentrating, difficulty completing tasks as instructed, or very poor ability to organize tasks.

Besides inattention, there are also symptoms of hyperactivity and impulsiveness. The most noticeable symptom is squirming even while sitting in a chair. A common symptom among the children in lower grades at elementary school is difficulty remaining seated at a desk. The student readily loses concentration and starts walking around or leaving the room. Or when the teacher gives an instruction, the student will start reacting before the instruction is completely communicated. Some of them have difficulty waiting their turn. If a student has 6 or more of these 9 symptoms, he will be diagnosed as hyperkinetic and having the impulsive type of ADHD.

However, don't forget that most children are restless when they are little. Therefore, ADHD is diagnosed if such symptoms are significantly outstanding compared with the average children of the same age. Diagnosis of ADHD will be made after the child has had various problems in daily activities for more than 6 months in more than 2 settings.

Many countries are now investigating how many people have ADHD in his country. China pursued such research in 1985, too. I do not think it was a nationwide survey, but it shows 6 percent of the children have ADHD. The figure for Japan is 3 percent but it doesn't mean we have fewer sufferers. Results vary slightly by survey method, therefore there should not be much difference between the two countries.

As a male, it is not easy for me to acknowledge that this disorder is overwhelmingly common among males. The percentage of males with ADHD is approximately 5 times higher than that of females. The incidence of ADHD levels off after adolescence, but an extensive survey in the United States shows 4.4 percent of the adults have inattentive symptoms. I will explain why it happens.

ADHD and Working Memory

When we see a child with these characteristic behaviors, we tend to think it is the parents' fault or the child is just being lazy. However, it is found that if a child has ADHD, 25 to 35 percent of his brothers or sisters also have ADHD and furthermore, even his parents have a quite high probability of ADHD. In fact, it is heritable.

Depending on surveys, the results somewhat vary in number but the ratio of patients with conduct disorders is 30 percent on average. The data show one of three children drifts into delinquency or has conduct disorders. And it is also found that ADHD patients have coexisting conditions.

It is important for preschool teachers to know that these children tend to have accidents and injuries very often. When I see these children at my clinic, I first look at their knees while talking to them. Most of them have a lot of wounds due to falling, scratching, or cuts.

It is found that the front part of brain, which is called a frontal lobe, does not work sufficiently in ADHD children. In a frontal lobe there is a place called working memory which is used for storing short memories. The working memory works a little less than well in children with ADHD.

Everyone has experienced a moment when the working memory is turned off. You went to the next room to get something, but as soon as you opened the door, you forgot what you wanted. That is exactly the moment when the working memory is off and it happens very frequently in children with ADHD. If you tell those children to do two tasks, they will finish the first one and then forget what to do next because the working memory is off. Results of a brain science research show they use much less glucose in the sinciput.

For these children, in fact, it has been proved that methylphenidate, brand name Ritalin, is effective. It is not prescribed in some countries and I don't know the circumstances in China, but it is known that this medication dramatically controls such symptoms. It is so effective that the symptoms disappear in more than 90 percent of ADHD children and for this reason, it is common in Japan to prescribe medication to children with severe ADHD.

However, more important than medication is how to educate or care for these children at home, kindergartens, or day-care centers. Better instructional materials and better teaching manuals are being devised for these children now.

Characteristics of Children with Autism

Now, I'm going to talk about autism spectrum disorders, especially about high functioning autism and Asperger syndrome.

In the diagnostic criteria there is a large group called pervasive development disorders and it includes autism and Asperger syndrome. Autism was first reported in 1943 by an American named Leo Kanner with data of his 11 young patients.

The first characteristic for autism is a delay in spoken language. Any child around the age of 3 is normally capable of baby talk at least, but autistic children develop language very slowly.

Personal interaction disorders, the second characteristic, are the most significant symptoms of autism. When we look at someone's face, we can tell instantly if he is angry or smiling or crying, but autistic children cannot.

The third characteristic is an obsessive attachment to certain objects. They tend to become preoccupied with just a part of a toy or get interested in very unusual things. This characteristic is also more common in boys. The number of the boys with this symptom is 4 times that of girls.

The next common symptom is tactile hyperesthesia. Upon hearing a loud noise, some autistic children will cover their ears with their hands and run away. Or they persist in wearing the same clothes all the time because they feel uncomfortable if they don't.

More than 80 percent of autistic children have mental and intellectual retardation. Conversely, 20 percent of them don't have intellectual retardation. Although their language development is very slow, they gradually start speaking. Furthermore, 15 percent of autistic children have epileptic seizures and tests show their brain waves are abnormal.

Characteristics of Children with Asperger Syndrome

Next I'm going to talk on Asperger Syndrome. Autistic children don't speak at all or just a little, but children with high functioning autism talk normally. As for Asperger syndrome, it is said that these children are exceedingly verbose.

Diagnostic criteria for Asperger syndrome are established, and these are the same as for autism. Children with Asperger syndrome are not able to engage in normal social interaction. They also become preoccupied with a certain thing or keep doing one thing repetitively. This kind of narrowly focused interest is another characteristic of Asperger syndrome.

The children with Asperger syndrome who are highly intellectual and extremely focused sometimes get misunderstood as child geniuses, especially when they are little. Some of them learn a lot of Chinese characters at the age of 3, or some are calendar savants who are able to instantly tell you the day of the week for any date 10 years in the future. Despite having these savant abilities, they have little ability for social interaction, which is a characteristic of Asperger syndrome.

Now what are the difficulties for Asperger syndrome children? They cannot understand expressions of the human face or eyes, so even if you scowl at them, the children with Asperger syndrome don't know what it means.

They are not good at understanding people's behavior, either. It is important for us to maintain an appropriate distance between other people and ourselves in social life, but they cannot do that.

As for language, they have difficulty understanding figurative speech. For example, some of the Japanese kindergarten teachers tell noisy children "Let's talk like ants." This instruction is a brainteaser because nobody has ever heard ants talk, but we can guess that ants would talk softly because they are small. This is metaphor or analogy that people with Asperger syndrome are unable to understand.

Because you are educators engaged in preschool education, you teach your students not to tell a lie, but you do tell lies every day, when you make flattering remarks, for instance. If the principal asks "How do you like my jacket I got in Shanghai the other day?", you say "Looks good on you" even if it doesn't. That is the proper response, but those who have Asperger syndrome have difficulty doing this.

These are not the only characteristics of Asperger syndrome, there are others as well, and they prevent children and adults with Asperger syndrome from getting along with other people even though they have normal speech and intellectual capabilities.

It is also well known that one person can have both Asperger syndrome and ADHD. The survey by Japan's Ministry of Education, Culture, Sports, Science and Technology shows that 0.2 percent of Japanese children combine three kinds of deficits which include autism, hyperactivity, and learning disability. It is 6.3 percent of Japanese children who have such development deficits, and 10 percent of American children, which means one of ten children shows those characteristics in the United States. Therefore, it is essential now for preschool educators to have not only educational and psychological knowledge but this kind of medical knowledge as well.

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