In Japan there is a system to evaluate children’s growth and development at the ages of 4 months, 8-9 months, one and a half years, and three before going to school. Those health checks are conducted by community health care centres in the city, town, or village. Paediatricians and/or community nurses will have interviews mainly with mothers and a few fathers, and evaluate the children’s health and behaviours. In Japan, it has been reported that fathers spend an average of seventeen minutes a day with their children.
It has proved to be a very effective system to discover children with major disabilities such as cerebral palsy, mental retardation, visual or hearing disabilities and congenital diseases. Families join the early intervention programmes to support their children in their development and to receive advice on their upbringing.
One day, a mother came with her 10-year-old son to my clinic on a nurse’s recommendation. She told me that the son could not concentrate on lessons at school. I managed to check his Intelligent Quotient and suggested to him that we study together. His face turned pale, he jumped up and ran out of the room. I could not understand what was going on in his mind at the time. I had an interview with his mother and phoned his primary school to talk to his homeroom teacher in order to obtain information on his academic performance in school.
Surprisingly I was not allowed to have any conversation with the teacher, even though I had permission from his parents to do so. Six months later I had a chance to discuss the boy with the homeroom teacher and the school nurse because the boy had started pulling out his hair and was becoming bald as a result of stress. I had earlier diagnosed him as being dyslexic and he had lost his self esteem because of the inappropriate and unsuitable teaching approach adopted by the teacher.
Since then there have been many similar cases from schools. Parents and teachers want to know how to deal with those cases. Professional assessment revealed that some cases of school phobia and/or psychophysical conditions are a result of an inappropriate support structure in schools coupled with developmental disabilities.
I emphasised that the boy needed special support in the classroom until he graduated from the school. At the beginning it was very difficult to get the teachers interested in his case. In my contact with him and his homeroom teacher during the first year, all the teacher did was discuss the boy with his colleagues, but in the second year, he had a new homeroom teacher who started to use a different approach with him which was helpful, and his symptoms reduced.
In my third year with this case, he had a new homeroom teacher and he was now in his final year in school. This teacher allowed him to use a calculator in the Maths class thereby giving him an edge over his mates. The use of a calculator helped to increase his class participation, his motivation and consequently, his self-esteem. He was quite happy to go to school regularly. Ten years have passed since then.
In 2003, the Japanese Education Ministry reported that 6.3% of children had behavioural and /or academic problems in mainstream classes in both primary and junior high schools. They might be sufferers of Attention Deficit and Hyperactive Disorders (ADHD), High Functioning Pervasive Developmental Disabilities (HFPDD) and Learning Disorders (LD). LD is known to affect reading, writing, listening and speaking skills. It also affects mathematics and imagination skills.
Support now mandatory
Since 2007, schools in Japan have been mandated to have support structures in place to assist students with the above mentioned problems. Every school should have a special needs education committee and special needs education coordinator. Special needs schools in the community have a special team consisting of specialists such as paediatricians, psychiatrists, psychologists, occupational therapists, university lecturers and other associated professionals. The team is expected to visit mainstream schools when requested, to assess designated students’ performance, and advise the school on how to handle such students.
Dr Kotani is a paediatrician with special interest in paediatric neurology. She has been involved with children with developmental disabilities for seventeen years, been on several Education Board committees, worked in hospitals and is currently a Professor in the Social Welfare Department at the Kogakkan University, Mie, Japan.