Hello. I am Naomi Sunami, specializing in developmental disabilities science, school clinical psychology, and educational psychology. I have experience working in various school settings, first as a teacher and later as a counselor and researcher. Once, when teaching at an elementary school, I encountered one child who repeatedly spoke out without raising his hand in class. Even after he was asked to raise his hand before speaking, he would not wait to be called on and made loud complaints. At that time, I could not help thinking, "What a difficult child he is! It is so hard to communicate with him." Later, after studying children's behavioral disorders I realized that the child was displaying signs of attention-deficit/hyperactivity disorder (ADHD).
After that, I took a Master's course in clinical psychology to study interactions with children from psychological perspectives. I also learned numerous things about children's developmental disorders. In addition, the stories I heard from a lot of children with developmental disorders were very different from what I had imagined.
After completing my Master's degree, I started working as a school counselor while also working as a teacher. Several years later, I took a Doctor's course to study teachers' involvement in the development of children including those with developmental disorders and while doing so met the mentor of my life.
Currently, I am teaching developmental disabilities science, clinical psychology at the university, while conducting research with support from local education boards and a number of teachers. In addition, as a school counselor I have to interview various children, parents, and teachers, listening directly to their stories and acquiring new knowledge. In this serial article, I will discuss the theme of "What adults can do for children with developmental disorder tendencies" to promote the understanding of those children based on my studies and experiences as a clinical psychologist and educationist. In Episode 1, I will explain the definition of developmental disorders and share a memorable story about one particular child.
Two definitions of developmental disorders
We often hear the term "developmental disorder" nowadays. I think almost all people will have heard this word. Nevertheless, there are probably very few people who can give an immediate answer to the question, "What is a developmental disorder?" I sometimes cannot help thinking that the word is widely used in society without being appropriately understood. Therefore, in this article, I will explain the definition of "developmental disorder (though I am reluctant to use this expression; I often use "developmental characteristics" instead) and how children with developmental disorders see our world. First of all, taking the example of ADHD (as mentioned above), I will explain two different definitions of developmental disorders in the contexts of educational and medical science. The first definition is quoted from the report of the Ministry of Education, Culture, Sports, Science, and Technology (2003)1, while the second is from the manual of the American Psychiatric Association (2013).2
Definition in the educational context
"Attention-deficit/hyperactivity disorder (ADHD) is a behavioral disorder characterized by inattention and/or impulsivity and hyperactivity which is not consistent with age/developmental stages. In people with ADHD, such behavioral characteristics can have a negative effect on their social life and academic performance. ADHD typically begins in childhood (before the age of seven) and often lasts into adulthood. It is assumed that ADHD is caused by functional incompetence in the central nervous system due to some unknown factors" (MEXT, 2003).
Definition in the medical science context
"A persistent pattern of inattention and/or hyperactivity/ impulsivity that interferes with functioning or development" (American Psychiatric Association, 2013).
In this article, I refer to DSM-5 for the medical definition of ADHD. DSM-5 is the latest "Diagnostic and Statistical Manual of Mental Disorders" published by the American Psychiatric Association in 2013. In the previous edition of DSM, ADHD was defined as having symptoms of "attention-deficit and disruptive behavior disorders" and broadly classified into the category of "a disability typically first diagnosed in babyhood, childhood, or adolescence" together with a pervasive developmental disorder, learning disorder, eating disorder, and so on. However, in DSM-5, ADHD, autism spectrum disorder (ASD), and specific learning disorder (SLD) are categorized in a newly established cluster of "neuro-developmental syndrome," a functional impairment typically found in children prior to entering elementary/junior high school.
In contrast, in Japan, ADHD, ASD, and SLD have been classified as developmental disorders since 2005 under the Act on Support for Persons with Development Disabilities, for which leading-edge approaches have been discussed. As you can see, not only the concept of developmental disorders but also medical diagnostic criteria will differ according to the times. In this regard, our knowledge and recognition of these symptoms might also change in the future.
Therefore, I hope the readers can keep this in mind and maintain a flexible perspective when reading my stories about children with developmental disorders.
Separation from Sho-kun at the time of high school graduation
I had known Sho-kun (alias) since he entered the high school where I worked as a school counselor. Sho-kun has ADHD and ASD characteristics. He had a chief complaint of difficulties adapting to school life due to his developmental characteristics. Children with both ADHD and ASD tend to have significant deficits in social processing, adaptive functioning, and executive control (Murray, 2010)3, thus facing more difficulties in addressing group activities, interpersonal relationships, and school education. Therefore, proper understanding and involvement are required for these children.
Although Sho-kun had no problem in his academic performances, he often got hurt due to his inattention and impulsive behavior patterns associated with ADHD. He also showed atypical judgments in daily school situations due to ASD symptoms, using loud abusive language toward his teachers or panicking and running out of the school premises. Each time, I talked with Sho-kun and discussed appropriate solutions with his supervising teacher. Fortunately, Sho-kun continued to meet with me for counseling.
In the last counseling session after the high school graduation ceremony, he had a surprise for me. He liked singing and sometimes sang a song in front of me, but something was different that day. He brought a small loudspeaker, played the instrumental backing to a farewell song, and sang for me. I could not stop crying while he was singing. Sho-kun, who had ASD and difficulty understanding people's feelings, expressed his deepest gratitude by singing a song for me.
When I was crying and feeling sad about saying goodbye to Sho-kun, he tried to comfort me saying, "You must have had plenty of farewells like this in the past, haven't you?" Then he said, "Separation is a start, not the end." Sho-kun, who was said to have difficulty understanding people's feelings, gave me his honest heart-warming words. What is a disorder characteristic? Sho-kun had such a warm personality.
I recall what Sho-kun said: "I often cause trouble in school and show teachers a rebellious attitude, but the person you are talking to right now is the real me." These words might have been said as he sensed my attitude toward understanding his psychological movements as a counselor. Another factor might be that I recognized the innermost kindness and goodness of Sho-kun, who cared for his younger sister and family very much, and that I believed in his potential.
Thank you very much for reading my story about Sho-kun, which is so valuable to me. In this series, I will write more about children with developmental characteristics so that you may deepen your understanding about them. I hope you will enjoy my stories.
- 1. Ministry of Education, Culture, Sports, Science and Technology. Final Report on the Future Direction in Special Needs Education.
https://www.mext.go.jp/b_menu/shingi/chousa/shotou/054/shiryo/attach/1361204.htm (Last viewed on September 8, 2022)
- 2. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders. text revision DSM-5 (5th ed.)
- 3. Murray, M. J. (2010). Attention-deficit/hyperactivity disorder in the context of autism spectrum disorders. Current psychiatry reports,12(5),382-388.
- 4. Sunami, N. (2022). Interpersonal interactions that nurture a sense of belonging and self-esteem among children with developmental disorder tendencies. IMAIBOOKS.
Associate Professor at Department of Psychology, Faculty of Liberal Arts, Teikyo University. Specialized in educational psychology, special needs education, and school clinical psychology and qualified as a certified psychologist, clinical psychotherapist, and clinical developmental psychologist. She has been working on research studies that contribute to children in the field of “Interactions between teachers and diverse children, including those with developmental disorders” from multiple aspects. She likes to spend time at her university, libraries, and cafeterias. Her publications include “Expertise of teachers treating children with developmental disorders” (Gakubunsha), “Interpersonal interactions that nurture a sense of belonging and self-esteem among children with developmental disorder tendencies” (Imaibooks), “Studies for the teacher training: counseling for teachers” (co-authored; Gakubunsha), “Future studies on teachers: 20 case studies for teaching methodologies” (TokyoTosho Co., Ltd.), and “Psychology of self-understanding” (Hokuju Shuppan Ltd.).
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