Something's Strange: Treatment of Developmental Disorders in Japan (7) Excessive Intelligence Testing (1) - Director's Blog



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Something's Strange: Treatment of Developmental Disorders in Japan (7) Excessive Intelligence Testing (1)


Among psychological tests for children, intelligence tests are well known. Intelligence tests were developed about 100 years ago as a method to objectively measure human intelligence by two French researchers, Theodore Simon and Alfred Binnet. One test used worldwide today is the WISC (Wechsler Intelligence Scale for Children), which was developed in the United States. Another widely used test is the Tanaka-Binnet Intelligence Test, an adaptation of Binnet's intelligence testing methods for use in Japan.

In Japan today, an exceedingly large number of intelligence tests are given even though they are not necessary. The tests are ordered from schools or medical facilities for developmental disorders.

In a previous article titled "Unnecessary Tests" in this series "Something's Strange," I noted that unnecessary intelligence tests were being given in medical facilities. According to Attention-deficit Hyperactivity Disorder-ADHD-Medical Care and Medical Treatment Guidelines, a book published by a research group in Japan, intelligence tests are considered "necessary" in the diagnosis of ADHD (Attention-deficit Hyperactivity Disorder), and this has come to be widely believed.

Because the research group conducted the study with research funding from the Ministry of Health, Labour and Welfare, the standards were misunderstood to be national standards. Today, the current situation has led to even further misunderstanding.

The drug methylphenidate used in the treatment of ADHD can only be prescribed by physicians who are registered as having received specific training. Recently, more requirements have been added. In addition to retaking the training via e-learning, the doctors who are already registered are requested to submit recommendations and case reports for the patients they have treated. Of course, the e-learning course is not compulsory, but if it is not taken, as of June 2020, a physician will not be able to prescribe this medicine to children with ADHD who have been receiving treatment. Treatment of ADHD with drugs takes an average of about three years. Even if physicians treating such children disagree, it is his or her responsibility as a physician to take the e-learning course and re-register.

The recent misunderstanding was prompted by e-learning material for doctors who are prescribing methylphenidate. In the material, an image explains the diagnosis of ADHD and also lists EEG and the WISC test as required. Most doctors should already know that ADHD diagnosis involves confirming whether there are symptoms that conform to those listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM)* or International Statistical Classification of Diseases and Related Health Problems (ICD)**, obtaining a detailed medical history, and confirming the patient's behavior at home and at school. However, with this new material, it is possible that some doctors will think that the EEG and WISC must also be conducted.

I immediately sent copies of the international standards and copies of the description stating that "the accuracy of diagnosis does not increase with psychological testing" and that "diagnosis is based on detailed observations of development and behavior" which have been published in neurology textbooks to the committee on e-learning and requested that changes be made, but I still have not received an answer.

In the past, I received an e-mail from a psychologist who had read the section "Unnecessary Testing" in "Something's Strange: Treatment of Developmental Disorders in Japan." In it, the psychologist explained:

"Recently, more children who are thought to have ADHD are receiving the WISC test, and the WISC test is hindering the testing of children who really need to be examined."

This excessive intelligence testing is not limited to the doctor's office. In another post, I will write about its overflow into education.

  • * The Diagnostic and Statistical Manual of Mental Disorders (DSM), published by American Psychiatric Association, provides guidelines for the diagnosis of mental disorders.
  • ** The International Statistical Classification of Diseases and Related Health Problem (ICD) is published by WHO and used as a diagnostic standard.
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.