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Something's Strange: Treatment of Developmental Disorders in Japan (3) Huge Misconception Regarding Developmental Disorders

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Today, I would like to write about the misconception that surrounds what we call developmental disorders.

Developmental disorder as the name (diagnostic name) of a condition is made up of very easy words. Everyone is familiar with "development" and "disorder." As such, everyone has his or her own interpretation of the meaning of these words. In other words, most will say they know what the term means.

In fact, this is the basis for the widespread misunderstanding that is the theme of this week's post. Taken literally, "developmental disorder" refers to a condition in which "development" is "disordered" or "hindered." The concepts of "development" and "disorder" can be interpreted broadly, so if "developmental disorder" is understood literally, it includes all conditions in which development is hindered.

Misconception 1: Is Intellectual Disability Also Considered a Developmental Disorder?

For example, because the condition of impaired intellectual development is considered to be an intellectual disability (medically speaking, mental retardation), there is a tendency to include intellectual disability in the category of developmental disorders. Today, although it is a fact that many people, among them specialists, still consider an intellectual disability to be a developmental disorder, intellectual disabilities are no longer included in the category of developmental disorders.

This view that considers intellectual disability to be a developmental disorder can be seen as a major factor in the name change of the Japan Association on Mental Deficiency, a major academic society for the research of intellectual disability, to its present name, the Japanese Association for the Study of Developmental Disabilities, and in the change of its publication name to The Japanese Journal on Developmental Disabilities. This publication publishes research on intellectual disabilities, including Down's syndrome and cerebral palsy. Looking at the history of the term "developmental disorder," there is a clear tendency to consider an intellectual disability as one of developmental disorders.

However, as noted above, intellectual disabilities are basically not included in the category of developmental disorders today. It was the Act on Support for Persons with Developmental Disabilities, which was passed in 2004, that has had a major influence on the definition of developmental disorders that is applied today. According to the Act on Support for Persons with Developmental Disabilities, "developmental disorder" refers to autism, Asperger's Syndrome, other pervasive developmental disorders, learning disabilities, attention-deficit hyperactivity disorder (ADHD), and other similar brain dysfunctions with symptoms that are generally identified at a young age (Article 2, Clause 1). While the law is not the answer to everything, developmental disorders are not considered to include intellectual disabilities, but are thought of as mainly comprising ADHD, Autism Spectrum Disorder, and learning disabilities (including similar conditions).

Misconception 2: Does "Developmental Disorder" Refer to Autism Spectrum Disorder?

If Misconception 1 explained above were clearly understood, Misconception 2 would not be a problem. There is a strong tendency for people, including specialists, to assume that the developmental disability refers to autism spectrum disorder and to use the terms interchangeably. I can point to several reasons for making this claim.

The other day, I watched a TV program on disabilities. It featured a hundred or so people with various disabilities and a number of popular comedians who asked them questions that would be difficult to usually ask so directly. It was a well-made program and the professional comedians skillfully stimulated discussion, but one thing bothered me. Each guest wore a name tag that also carried the name of his or her disability, such as cerebral palsy, epilepsy, etc., and among them some wore a name tag saying "developmental disorder." As stated earlier, "developmental disorder" is a general term that includes three types of disorders--it does not refer to a single, specific one. As for those who were wearing this name tag, it was not possible to know which of the three disorders they had. This is no different from a heart attack patient wearing a tag marked "cardiovascular disease" or someone with an ulcer wearing a "digestive disorder" tag.

This tendency is evident not only among the general population, but also among specialists. When a person with a disability applies for a pension (national pension, employee's pension, or one regarding mental disability), it is necessary for a physician to provide information regarding the applicant's symptoms. The physician then selects the type of mental disability and its symptoms. The form includes a category of "symptoms related to developmental disorders," and the physician must select more specific symptoms. Only the following are listed: "1. Qualitative deficits related to social interaction; 2. Language and communication disorders; 3. Limited stereotypical and repetitive interests and behavior; 4. Other." A closer look reveals that all are symptoms of Autism Spectrum Disorder (ASD). While attention disorders and learning disorders are listed, they are grouped under the category of intellectual disabilities. Supposedly made by specialists, this application form shows us that this is how the comprehension is even among specialists.

Such examples are too many to count. I think this is due to past history and the fact that autistic spectrum disorder was called by the ambiguous name "pervasive developmental disorder," but given that this sort of ambiguity exists among specialists, it is not surprising that misunderstanding exists among the general public.

In an earlier book, a specialist in developmental disorders stated that rather than citing specific diagnostic names such as ASD or ADHD, it may be more convenient to group these conditions under the broad rubric of developmental disorder, but I am unable to understand what enables this way of thinking. That is because while common aspects might exist, the three disorders differ totally in terms of pathological condition and corresponding treatment....

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sakakihara_2013.jpg Yoichi Sakakihara
M.D., Ph.D., Professor Emeritus, Ochanomizu University; Director of Child Research Net, Executive Advisor of Benesse Educational Research and Development Institute (BERD), President of Japanese Society of Child Science. Specializes in pediatric neurology, developmental neurology, in particular, treatment of Attention Deficit Hyperactivity Disorder (ADHD), Asperger's syndrome and other developmental disorders, and neuroscience. Born in 1951. Graduated from the Faculty of Medicine, the University of Tokyo in 1976 and taught as an instructor in the Department of the Pediatrics before working with Ochanomizu University.
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