There have been several times when a patient's condition improved after I prescribed new medication for the first time and I considered writing a paper about it for publication in a medical journal. Such papers, however, are generally not selected for publication. As a standard reason for rejection, editors often acknowledge that the paper is very interesting, but cite anecdotal content as the reason. Anecdotal content refers to information about something that happened to be effective for one patient, but that does not necessarily mean that it will have the same effect on other patients.

Perhaps what I will be writing in this blog from here may be considered "anecdotal."

A four-year old boy came to me for consultation. In the case of a first visit, before asking the parents the reason, I usually ask the child a number of questions directly and communicate with picture books and toys to check characteristics of the child's behavior and understanding of language and instructions. Through this sort of exchange in the consultation room, it is possible to make a general judgment regarding intellectual disability or autism spectrum disorder (ASD). On the other hand, in the case of attention deficit hyperactivity disorder (ADHD), it is possible to make a presumption based on certain behavior by the child such as moving around the room, spinning around on the chair, and touching things on the desk, but it is usually hard to make a judgment without asking specific questions about behavior in group activities at school and daily life at home.

This particular four-year old boy had no trouble answering my easy questions (name, age, favorite food, etc.) or giving the correct answers when asked the names of things shown in picture books and their use (scissors for cutting and clipping; a hat to wear on your head). Rather than an intellectual disability or autism spectrum disorder, it seemed to me that his condition, if he had one, might be attention deficit hyperactivity disorder (ADHD). With this in mind, I had the parents complete a checklist for ADHD, and as I had expected, the high score indicated possible ADHD.

It was then that I first asked the reason for seeking a diagnosis. The parents had been told that the child was not good at group activities and often engaged in deviant behavior, and they were advised to transfer their child to a kindergarten with special needs class. Being familiar with such complaints, I expected answers that cited behavior such as going out of the room alone, completely ignoring instructions, or running around and being unable to take part in everyday activities with others. However, I was quite surprised when the mother told me about the nature of this "deviant behavior."

During the craft class when they were supposed to be making spinning tops out of acorns and playing with them, he had removed the sticks (toothpicks) that were stuck in several tops. When the teacher was showing the drum to everyone and demonstrated how to play it, he came forward and touched the drum. In the sandbox, he used tin can stilts (a toy made from cans with a rope tied to it for riding) as a bucket. I don't understand how such behavior is considered to be deviant behavior.

Any kindergarten teacher knows that all children grow and develop as they freely explore through play. And the three activities cited above as deviant behavior are all free, exploratory activities by children engage. If a child sees something like a stick protruding from an acorn, which they are familiar with, it is a very natural response to explore further and pull it out. Using tin can stilts as a bucket can be seen as an innovative act that uses the item for something other than the standard way. This creative act of exploration is fundamental to children's play.

What surprised me is that among kindergarten teachers, who are professionals in child education, there were those who could only view it as deviant behavior.

Rather than medical treatment for ADHD in childhood, the method that is usually applied attempts to change behavior through more open and receptive childcare, so for this four-year old child, I only recommended transferring to a different kindergarten.

I just hope this sort of kindergarten (teacher) to be anecdotal.