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Something's Strange: Care and Treatment of Developmental Disorders in Japan

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In a previous blog, I wrote about the overdiagnosis of developmental disabilities in Japan. And since then, I have continued to see a number of children who appear to have been overdiagnosed.

One patient was a nine-year-old boy who came to see me with his parents for getting into trouble at school for getting into a heated argument with a friend and making him cry. He was diagnosed as having a developmental disorder by a local doctor specializing in developmental disorders, but his parents brought him to me because they were not convinced of the diagnosis.

When a child comes for a first consultation, I make it a practice to talk to the child directly before asking the parents about the reason for the visit. Since all children tend to be wary and afraid of doctors, I start by asking their name, age, birthday, and favorite food, namely, questions that are easy to answer. This nine-year-old boy was not only wary, but a bit hostile. No doubt, he thought I would ask about how he made his friend cry. Showing a slightly rebellious attitude that seemed to question why he had to answer my questions, he answered reluctantly, but accurately.

When I asked his mother about his grades in school, she told me they were average. Based on her answer, I was able to assess that his intellectual development was within the normal range. Furthermore, his precise answers to my questions and expression of dissatisfaction with hospital tests indicated a low possibility of autistic spectrum disorder, so I asked his mother why she had brought him for a diagnosis.

The mother then handed me the medical report written by a local doctor, "a specialist in developmental disabilities," which indicated an unbelievable diagnosis: it said the boy had "a severe case of autism."

The medical report included a checklist for autism, and the diagnosis was based on the fact that the boy had been unable to answer the standard number of questions. When I asked the mother about this, she replied that the boy had been defiant and deliberately refused to answer the doctor.

I was astonished that a doctor would make a diagnosis of severe autism based solely on a checklist and without recognizing the contradiction of making such a diagnosis of a child in the third grade of elementary school with average grades and the ability to make his friends cry in arguments. This might sound a little strange, but getting the better of a friend in an argument requires a rather good ability to "understand the intention of others."

This young boy was in my thoughts for some time, but recently, I experienced something that shocked me. It was a boy in the third grade of elementary school who was refusing to attend school. He didn't want to enter the room, and when I started asking him some questions, certain characteristics became apparent.

"How old are you?" I asked, and he answered, "Two years old." "What's your favorite food?" "My mother." "What's your least favorite food?" "My mother." In response to his answer on a questionnaire that he liked to draw, I asked "What kind of pictures do you draw?" He answered, "I don't know." The only question that he answered in earnest was "What do you want to be when you grow up?" "A researcher."

Talking with his mother alone afterwards, I pointed out that the boy deliberately gave wrong answers to my questions. His mother confirmed this, "Yes, that's right. He understands everything. The other day, he agreed to take an intelligence test." She brought the test result which showed he had an IQ of nearly 150.

Since kindergarten, the boy had always been scolded by teachers for refusing to do what he did not want to do. Gradually, his reaction against teachers intensified, and because he was suspected of autistic spectrum disorder for not following directions, etc., it was decided to place him in a special education class. This class, which consisted solely of basic instruction that was not for a specific age group, only increased his resistance, and this experience then ended in his refusal to attend school altogether. His mother's biggest concern was that although he used to listen to her, he had recently had started disobeying her, too.

I explained to his mother that not answering questions and not following instructions were not due to an inability to understand what was being asked, but rather due to a rebellious attitude. His mother nodded in agreement and added the following: "I think that sending him to a special education class made his condition worse."

Does this experience bring anything to mind? I think this student is one of the gifted children who were misdiagnosed and was the subject of an article by Dr. Shiori Sumiya. In Japan, for gifted children like this, who do not follow the usual development, there are only special support classes. Perhaps this situation in Japan is cause of the refusal of such children to attend school?

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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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