The concept of learning disabilities is an interdisciplinary concept spanning medical care, education, psychology, welfare and labor. The history of its rapid spread as an educational concept in Japan is presented alongside review of the trends leading up to establishment of the concept in different countries. Through international comparison of learning disorder as a category of disability, some points of importance are submitted regarding desired paths of future development.
Assessment tests for Specific Learning Disorders (SLD) as defined by the DSM-5 were overviewed. Starting with the transition in diagnostic criteria, assessment methods covering general intellectual capacity, academic proficiency, and cognition including tests on phonology, automatization, visual cognition, and vocabulary were discussed. Proficiency and cognitive tests can exclude environmental factors as the cause, and the ability to estimate and diagnose SLD using objective methods is a notable characteristic of the disorder. Reference is also made to the cognitive tests helpful in determining needed support and applicability of established evidence-based methods of teaching and support, with particular regard to problems with reading and writing of the Japanese language.
Ratification of the Convention on the Rights of Persons with Disabilities in 2014 promoted investigations in support of “reasonable accommodation” for persons with disabilities in Japan, including development of the legal foundations. This paper overviews the circumstances surrounding reasonable accommodation in present-day Japan, and examines the key issues of accommodation affecting people with specific learning disorders. Further, the role of medical institutions to ensure appropriate application of reasonable accommodation for persons with specific learning disorders are discussed in terms of diagnostic concerns, and recommendations regarding psychoeducation, environmental coordination and adjustment for these individuals.
According to a report by the Ministry of Education, Culture, Sports, Science and Technology (2012), about 4-7% of children enrolled in the regular compulsory education school system in Japan are suspected of having some form of learning disability (LD). However, only about half those children have been provided with additional support. In general, educational support starts with the identification of children with LD using standardized tests. It is regrettable that few such tests for LD are available for children in Japan. Implementing the Response to Intervention model is a possible alternative in the school setting, although it would require additional training of teaching staff to enhance their skills for supporting children with LD. Within the current framework of special education, children with LD alone can only be enrolled in regular classes, with access to additional support from special needs education teachers in special resource classrooms in schools allocated such staff. There are two possible courses of support. One is training in reading, writing and calculating. The other is provision of augmentative and alternative tools as a measure of reasonable accommodation of individual difficulties. This paper describes some such ways of support through presentation of a fictional case. And last, recognizing the importance of diversity in the classroom was emphasized for the successful provision of effective support to children with LD in the regular classroom setting.
The development of innovative Information Communication Technology (ICT) devices and applications has made it possible to support the reading and writing abilities of students with Learning Disabilities (LD). At the same time, improvement of the legal and social infrastructure has enabled provision of resources including printed textbook material in alternate formats tailored to the needs of such students. The result of these innovations has been the development of increasingly digitized educational systems capable of providing students with LD the potential of classroom participation at levels comparable to their peers.
However, despite such technological developments and institutional improvements, therapeutic training in the form of drills and practice techniques remain the principal approach in special needs education and rehabilitation programs in Japan to date. This type of training may be effective for some, but is not suited to all, and it has been demonstrated that ineffectual training can further exacerbate delays in learning, lower motivation, and obliterate self-efficacy. However, ICT is not a cure-all, and their use cannot solve the problem on its own, particularly when introduced after a student has fallen greatly behind, or is forced upon children who have lost the desire to study. Once motivation is lost and failure becomes the norm, children disengage and fall behind their peers. Many students also develop negative attitudes towards the use of textbooks, linked with poor performance in the past.
Activity-based subject learning (ABSL) in forms such as cooking and interactive games has proven effective in enhancing motivation in such cases. Teachers provide learning cues to children through conversation, not textbooks. In this article we introduce the idea of multimodal approaches starting with the benefits of incorporating the Response to Instruction model for early intervention; validity of ABSL tailored to individual strengths, interests and needs; ICT use in the classroom, for assignments, and in examinations; considerations for overcoming resistance to ICT use and promoting the principle of reasonable accommodation; and ABSL as an educational intervention for LD children with low motivation, where teachers step up ICT use and draw upon a wide array of teaching methodology to offer classroom instruction the children with LD can relate to with their individual skill sets.
Background: Food selectivity is commonly reported in children with autism spectrum disorders (ASD). Objective: This study aimed to investigate the food repertoires of children in Japan with ASD in relation to nutrient inadequacy. Method: Three-day food records completed by the parents of children with ASD were compiled into food repertoires defined in this study as the number of unique foods consumed over three days, for assessment of nutritional adequacy of these children's diets. Nutritional parameters included energy, protein, vitamins A, B1, B2, B6, B12, and C, niacin, folate, calcium, magnesium, iron, zinc, copper, iodine and selenium. Results: Twenty-four participants were enrolled in this study. Significant inverse correlation was observed between the number of different foods consumed and nutrient inadequacy (r=-0.56; P<0.01). Nutrient inadequacy was common for vitamin A, calcium, magnesium, and zinc. Five participants with severely limited food repertoires did not meet the estimated average requirements for specific nutrients. Their food repertoires consisted of primarily rice (n=5), snack foods (n=4), tea, fried potatoes, bread, milk, fried chicken and eggs (n=3). Conclusions: A limited food repertoire is associated with nutrient inadequacies. Unlike studies conducted in Western nations, rice was among the foods most favored by children with ASD in Japan. Rice lacks in vitamins A and D, and physicians and dietitians caring for children with ASD need to be aware of such nutritional deficiencies arising from food selectivity.
Objective: The present study surveyed the status of school-refusal patients attending a child and adolescent day care service, in terms of rate of return to school, Global Assessment of Functioning (GAF) scores, and prognosis as indicated by course after graduation from junior high school, in order to examine the role and significance of such services.
Method: A retrospective investigation was conducted on the medical records of 32 patients (22 boys and 10 girls; 7 elementary and 25 junior high school students; aged 9-15 years) with chief complaints of school refusal, utilizing the child and adolescent day care service of an outpatient child psychiatric clinic.
Results and Discussion: The most prevalent diagnosis among the patients was developmental disorder (n=21 [65.6%]). Mean age at the start of using the service was 13 years 2 months, suggesting association with the transition on to junior high school. Patients were classified into four groups based on course of treatment (course of day service use). The groups who continued with day care had a good prognosis with higher GAF scores, rates of school return, and admission to senior high school. Conversely, the group who discontinued day care had a poor prognosis, possibly linked to subsequent hikikomori. The findings demonstrated that the child and adolescent day care service was functioning as: 1) a temporary refuge from a critical situation; 2) a place offering a sense of safety; and 3) a secure base from which to tackle the outside world. Children appeared to be using the day care service as a temporary refuge from critical situations, and given a place where they could feel safe, were gradually regaining a sense of energy through interaction with peers, enabling them to take on challenges such as returning to school or tackling other aspects of the outside world, and facing their future. While the present findings suggest that child and adolescent day care services are beneficial as a place of support for children refusing to attend school, the issue of support for patients who discontinue attending such services remains unresolved.
The recent social situation and prevalence of natural disasters have increased the likelihood of children undergoing traumatic experience, heightening the demand and expectation for further research on effective treatment for childhood trauma. According to the National Institute for Clinical Excellence (2005) and the World Health Organization (2013), the recommended treatments are cognitive behavioral therapy (CBT) and eye movement desensitization and reprocessing (EMDR). However, few studies on these modes of therapy have targeted children to date. EMDR is a psychotherapy created by Francine Shapiro in 1989. While recognized as an effective treatment for trauma, there is comparatively little research on EMDR among children and adolescents. In this systematic literature review, we have sought to determine the current state and issues surrounding EMDR research overseas, for delving into the means of adapting EMDR for use with children in Japan. We reviewed 56 foreign and 32 domestic articles, which were classified into four types: assessments of effectiveness, reviews, clinical case studies, and other introductory reports. Among foreign articles, there were 20 assessments of effectiveness, 12 reviews, 18 case studies, and 6 other introductory reports endorsing EMDR as an effective mode of psychotherapy for children and adolescents. Review of these studies highlighted the need for basic research targeting specific issues using methodology allowing for accumulation of valid evidence. On the other hand, the domestic articles included no assessments on effectiveness or reviews, and were limited to 9 clinical case studies, and 23 other introductory reports. Clearly, more evidence is needed to establish both efficacy and reliability of EMDR in Japanese children, alongside stepped up study in both basic research and the clinical applications of EMDR.