When examining a child for the first time, before reading the letter of introduction or talking to the parents, I ask the child some questions and watch the reaction closely. The questions vary depending on the age. If the child is 2-3 years old, I ask "Show me your hands" or "Open your mouth wide." Or I point to a picture book and ask "Where's the elephant?" or a similar question. For older children, I ask "What's your favorite food?" or "How old are you now?" For elementary school students, the usual questions are "What's your favorite subject?" "What subject don't you like?" or "What do you want to be when you grow up?" In this exchange with the child, it is possible to confirm the level of verbal understanding, understanding of the intentions of others, and check the action of pointing. As for the social skills of older children, I ask a difficult question in the presence of a parent, for example, "Who do you like more, your mother or father?" If the child answers "I like both" or "I like them to the same degree," it is an indication that the child understands the question and chooses to answer diplomatically. In most cases, children with autism spectrum disorder (ASD) are not capable of such calculation.
A seven-year old boy who came to see me for the first time at the beginning of 2020 answered my questions without pausing for a second. When I asked if he liked studying, he answered "I like art," and when asked what subject he didn't like, he answered "class activity." Students often cite "Japanese language" as the subject they dislike the most, so I was not expecting that answer and stopped for a moment. I then asked "Are you afraid of your teachers at school?" As expected, he replied "They scold me if I play around, so I'm sometimes afraid of them." Based on the fact that he was answering my questions smoothly and with ease and replied that he wanted to be a scientist who does research on outer space when he grows up, he did not appear to have any signs of autistic spectrum disorder. I had his mother complete a checklist for hyperactivity, and it was also well within the normal range, so he did not appear to have ADHD either.
I wondered about the reason for coming, so my first question to his mother was "Since he doesn't appear to have autistic spectrum disorder or ADHD, what were you worried about when you brought him for a diagnosis?" With a look of relief, the mother began with "I'm glad to hear you say that," but I was moved by what she said next.
"Actually, at the last parent-teacher conference of the first term, the homeroom teacher suggested that my son start attending special support classes for children with special needs. He ended up not attending and nothing was said about this in the second term, so I kept wondering if he really had a developmental disorder. What you have said so clearly now makes me feel relieved."
When I asked what sort of problems made the teacher recommend attending special support classes, the mother took out a memo from the teacher and read "He takes time switching from one task to another and he doesn't understand instructions given to the class." I told her that it was something called the "first grade problem," a common behavioral feature among children who find it difficult to shift from the daily life pattern of daycare center and kindergarten to that of elementary school. Many children display such behavioral characteristics in elementary school. I explained that this most likely pertained to her son and that was the end of the diagnosis. Of course, the seven-year old was a healthy child.
Previously, in this blog, I wrote about school teachers becoming too sensitive about developmental disorders, but parents are also becoming too sensitive about what the teachers say. This mother was troubled for over half a year by the comments of the homeroom teacher.
During a medical examination, pediatricians tend to tilt their heads a little as they say "Let's wait and see," and such slight gestures can cause the parent to feel worried. For this reason, it is important for doctors to be careful about their language and behavior during such check-ups, but this may also apply to teachers at school.
Note: Dr. Sakakihara has published a book in Japanese, Kodomo no hattatsu shogai / goshin no kiki (Developmental Disorders in Children: The Crisis of Misdiagnosis; Poplar Publishing Co., Ltd.), that discusses the topics addressed in the section "Something's Strange" of the Director's Blog. It is recommended for further reading regarding his views on developmental disorders in Japan.