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Something's Strange: Treatment of Developmental Disorders in Japan (6) Are Schools Overreacting?

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As I have considered society's understanding of developmental disabilities to be inadequate, over the past twenty years, I have actively made an effort to broaden this understanding through lectures and by publishing books for the general public.

It is widely known that developmental disability is a general term that includes different disorders such as attention-deficit hyperactivity disorder (ADHD), autism spectrum disorder, and learning disorders, and for this reason, diagnosis can be difficult. Overdiagnosis, which I have also discussed in this blog, is one problem that has resulted from this situation. My intention of describing the behavioral features of attention-deficit hyperactivity disorder (ADHD) and autism spectrum disorder in simple language as "worrisome behavior" was a way to facilitate understanding in society at large.

Now, however, I feel that by using such a simple expression, I may have contributed to the tendency in childcare facilities and schools to easily associate "worrisome behavior" that is not related to developmental disorder with developmental disorders, and this calls for some reflection on my part.

One five-year old girl came to me for consultation because she was told by her kindergarten that she might have a developmental disorder and should see a specialist. The reason given was that she did not follow the teacher's instructions.

As for this "worrisome behavior" that was equated with not following the teacher's instructions, it could be considered an inability to understand the language of the instructions due to an intellectual disability, an inability to understand the meaning of the instructions given in a group setting due to autism spectrum disorder, or the inability to listen to instructions because of distraction due to attention-deficit hyperactivity disorder (ADHD). With this in mind, I began talking with the girl and asked her questions. She had no trouble telling me the name of her kindergarten and her favorite food, and answering other questions. I asked about her activities at home, and there was nothing that indicated lack of attention, hyperactivity or similar behavior. When I asked her parents if there was any problematic behavior at home, the answer was "She is stubborn and when she is absorbed in something, she can't easily stop." I was also told that her kindergarten was one known for its strict discipline.

With this, I began to understand. The five-year old girl was a short-tempered child (stubborn and self-assertive). I gave my view that the child's disposition and the kindergarten's policy were a mismatch. When she came for another appointment, I learned she had changed kindergartens and was having no problems at the new kindergarten.

Let me introduce another recent experience. A boy in fifth grade who came to me had been told by his teacher that he should "see a doctor and take some medicine." The reason for his consultation was that he had had an argument with a classmate whom he did not get along well with, and as a result, the classmate had not been attending school regularly. His mother spoke painfully about being blamed by the parent of the other child who now refused to attend school. The fifth-grader was a pitcher on a little league baseball team, so I asked the usual question, "What do you want to be when you grow up?" and he answered "a professional baseball player."

When I asked his mother if he got along well with the members of the baseball team, she answered he had had difficulty with social relationships in the past, but he was doing well now. His grades were about average and he answered my questions well, so I didn't see any signs of intellectual disability or communication problems. I asked his mother to complete a checklist for ADHD to see if he showed signs of hyperactivity or impulsive behavior. A list of questions alone is not sufficient to make a diagnosis, but it is helpful in identifying certain tendencies. Nevertheless, even the ADHD checklist did not indicate a high level of hyperactivity and impulsive behavior. The teacher who recommended that he go to a doctor was strict and had often scolded the boy, and the boy admitted that he didn't like the teacher much either. Moreover, in the lower grades of elementary school, he had not had any problems with school life and his parents had never had talked with teachers at the time about his condition.

In my view, this situation was also caused by a mismatch between the current teacher and the fifth-grade boy. If a child has a developmental disorder, including attention-deficit hyperactivity disorder (ADHD), the symptoms usually become apparent in daycare center, kindergarten or the lower grades of elementary school. In this boy's case, I reached this diagnosis based on the fact that he had no symptoms until reaching the lower grades of elementary school, and the examination and parental checklist showed nothing that would indicate a developmental disorder either.

In some cases, worrisome behaviors perceived by teachers are surely a sign of a developmental disorder, but this can often be explained by the child's temperament and compatibility with the classroom and school. Of course, children who appear to need help can continue to be introduced to medical facilities, but before that, I would like to see teachers make use of their experience and attempt more fully to consider the possibility that apparently inappropriate behavior may arise from or be the result of a mismatch between the child's temperament and the kindergarten or school.

Am I the only one who feels that kindergarten and schools are overreacting to developmental disorders?

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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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