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Mitsuru Yamashina

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Background to support for those with developmental disorders at university

Mitsuru Yamashina
Professor of Clinical Psychology, Faculty of Letters, Chuo University

From 2012, as a member of the Chuo University joint research project Research Related to Understanding the Situation of Students With Developmental Disorders at Chuo University and Offering Education and Development Support, along with professor Manabu Tsuzuki, majoring in psychology in the Faculty of Letters (research leader), professor Akira Midorikawa, former professor Yasuko Kamibayashi, and new member, professor Shinichi Miyazaki, Faculty of Law, I am conducting research study. Last year, with the cooperation of many faculty staff members, a whole-campus study took place, with a part of it distributed around the university in the form of a mid-term report. This essay describes the circumstances behind this research study.

1. Developmental Disorders ~From a legal aspect~

The term developmental disorder is difficult to understand. Developmental and disorder are extremely normal words, but when put together, they become a special term with a narrow meaning. While avoiding going too far into the essence of the term, here I would like to refer to the definition of developmental disorders from a practical viewpoint. In the Act on Support for Persons with Development Disabilities, passed in 2004, developmental disorders are said to be autism, Asperger Syndrome and other pervasive developmental disorders, learning disorders, ADHD, and other similar brain dysfunctions, and the appearance of such symptoms at a young age. (Table 1).

Table 1: Developmental disorders and characteristics
Category It’s Characteristics
Learning Disorders (LD) Shows extreme difficulty in specific ability like reading, writing or calculations
Attention-Deficit / Hyperactivity Disorder (ADHD) Inattentive, unsettled, and shows impulsive behaviour
High Functioning Autism / Asperger Syndrome Has trouble in personal relations and sociability, unbalanced interests, and communication troubles

Before the enactment of this law, policies toward general developmental disorders (so-called intellectual disabilities) and typical autism, were carried out in both educational and welfare aspects. With developmental disorders like those above being defined in this law, an urgent problem that has arisen through feedback from the workplace and research studies is that, among the people who had these conditions while attending normal classes and progressed onto university and work, a large number are in need of support.

For that reason, it is stipulated in Article 8 Section 2 of the same law that appropriate educational consideration is to be given to those with developmental disorders, in accordance to the level of that disorder, in universities and higher professional school. Simple examples of this are giving educational consideration to those with developmental disorders such as providing barrier-free facilities for wheelchair users at university or having note-taking volunteers provided for the visually impaired and the hearing-impaired.

2. Brain dysfunction in developmental disorders

The term brain dysfunction may need some explanation. Organic disorders are compared with functional disorders. Organic disorders are the onset of physical changes such as the death of neurons through the existence of a brain hemorrhage or injury, or a tumor, resulting in the exhibition of neurologic manifestations (motor impairments and disturbance of consciousness etc.) or mental manifestations. On the other hand, functional disorders are recognized generally by the appearance of speech and behavioral abnormalities (including in examinations or self-assessment scales) without identifying physical change to the brain.

Speech and behavioral abnormalities are divided into qualitative and quantitative abnormalities. Qualitative abnormalities are the observation of phenomena which were previously non-existent. Auditory hallucinations are said to be an example of qualitative abnormality of a brain function. Quantitative abnormalities are those which are usually present in everyone, but quantity (or strength) is extremely unbalanced. For example, everybody has some sort of preference, but the strength of that preference is extreme and impedes adaption. Discussing the amount of something which can not be directly measured from the start first becomes possible after procedures that quantify subjects using scales (evaluation scales) for measurements. Because these procedures are complicated, there are many cases where even professionals on clinical sites rely on experience and intuition when identifying and evaluating symptoms. This is one of the reasons professional evaluations are felt to be lacking in reliability.

It is believed that the brain consists of a mixture of various functions acquired in the evolution process. If conforming to this line of thought, it can be said that developmental disorders are the result of disorders (quantitative abnormalities) in a specific function such as learning function, concentration function or function regarding human relationships or more. In other words, what makes it difficult to adapt to society after the occurrence of extreme imbalance (irregularities) in capacity responding to brain dysfunctions at the base is developmental disorders. I would also like to add that disorders in developmental disorders are not fixed and that, rarher, the essence is delay in development and growth promotion support is needed. (Kazuhiro Takikawa: Kokoro No Honshitsu To Wa Nanika (What is the Essence of the Heart?)

3. Students with developmental disorders are easily misunderstood

Because their disorders can not be seen, it must be extremely difficult for those without specialist knowledge to notice students with developmental disorders who enter university. For example, there may be comments such as, “how did they get into university?” aimed at students who can not understand simple rules or instructions for course registration. In seminars, students who only talk about their interests and can not join in discussions with others would be said to be self-centered. Wouldn’t students who don’t hand in work that was assigned verbally by the teacher be seen to be unmotivated? Those who often forget things and are not punctual are rejected from the outset in job-hunting activities as being slack. Among those troublesome students may actually be some who are considered to have developmental disorders. Those who proceed through to university, without having their disorders diagnosed, hit hurdles at the start of university, in their third year seminars, and during job-hunting activities.

Characteristics of the above are cases where the students do not particularly perceive any difficulties and the people around them agonize in how to deal with them. Especially in personal relations, every now and then there are examples like those involving characteristics such as a lack of empathy and cooperation. However, in my experience, when delving deep after developing a close relationship, there are many cases with a uniform rationale in their words and actions where the lack of empathy and cooperation that appears in their words and actions acts as their safeguard (heart amour). Conversely, those who are well aware of what people around them are thinking, have a low self-assessment of themselves due to this. Students who make efforts but do not improve are likely to be seen by others to have a personality problem, and in turn, take on a negative self-identity (an “I can’t do it anyway…” line of thought and attitude), and lose hope.

4. Support at university ~Referring to other universities~

Support for students with developmental disorders at university has only just begun, and many universities are at the stage of feeling things out. In the joint research project, we observed the advanced activities taking place at the University of Toyama, and gained many ideas. I will introduce some of them here.

In the case of the University of Toyama, total communication support section has been set up in a student support room, creating a system which offers versatile support for students with developmental disorders. A specially appointed associate professor and a full-time psychologist have been assigned to the support section, and together with two full-time teachers belonging to the student support room, provide support in a full-time four person support system. Unique to this system is its use of a social networking system, making it possible for students to have 24 hour access to the support system. Cooperation with educational affairs and career support is also smooth. These are conducted by the student support room, which was originally intended to provide one-stop service, and from the position of the students is a place where you can receive necessary support on-the-spot without being sent all over the place regardless of which counter you visit.

Here, necessary support is not necessarily limited to needs realized and expressed by students. There is a wide range in student self-understanding. Support is also regardless of having a medical diagnosis or not. A stance to provide suitable support to troubled students depending on the state of their situation is important. A direct cause for the creation of this support system was a spate of student suicides, and a result of attempting to create truly effective measures led to the current system.

What kind of system can be set up at Chuo University? What types of needs are there, and what do we aim to achieve? Even within the project, discussions have only just begun.

5. Final word ~As a psychiatrist~

As a psychiatrist, I have performed treatment and counseling at clinics and health management centres at companies, and in the past I have encountered youths with developmental disorders who have maladjusted within one to two years of employment. In the past few years, the word Asperger has become a general term, and furthermore, since from around last year, whether there has been an influence by the energetic awareness campaigns by pharmaceutical companies in relation to ADHD (I certainly don’t want to touch on that topic here,) there has been a rapid increase in young people taking themselves to clinics for developmental disorder diagnoses and treatment, and recently, my outpatient clinic has taken on the look of an adolescent development disorder outpatient clinic.

Many of these patients, while at some point in time having realized that, “there is something strange about me,” or “I am different from others,” have grown up so far while facing hardships. However, they have continued to battle by themselves without talking it over with others, and seek consultation when they hit a dead-end. Although they know in advance that there is a limit to support in medical models, they come to the clinic in desperation from a strong feeling of dejection. Every time I meet one of those youths I can’t help but think, “if you had sought help earlier, things would have turned out different.”

It is an idealistic theory but, a society that is easy for those with developmental disorders to live in would be, without a doubt, easy for those without disorders to live in, too. If the university campus was developmental disorder student-friendly, and a place where they could assuredly deepen their self-understanding and grow, then it would be a comfortable place for many of the people who create that campus. My request is that universities become places like that.

While being careful with what I say, we must start with the small things in front of us and apply ourselves steadily. Gaining support from many colleagues on campus, I would like to provide support, which gives hope for the direction of their future during the time at university, little by little to students with developmental disorder who are at a loss.

Mitsuru Yamashina
Professor of Clinical Psychology, Faculty of Letters, Chuo University
Born in Aomori Prefecture in 1961.
Graduated from the School of Medicine, Niigata University in 1989.
Entered current position in 2010 after working as a member of the medical staff at Tokyo Metropolitan Matsuzawa Hospital, assistant and lecturer in the Faculty of Medicine, Juntendo University, and professor in the Faculty of Human Sciences, Bunkyo University.
Doctor of Medical Science (Juntendo University), certified psychiatrist, and clinical psychologist.
Majors in adolescent psychology and psychoanalytic psychotherapy. Is involved in clinical research with the aim to be a bridge between the clinical sites and education in psychology.
Major publications include Seishin Bunsekiteki Hattatsuron No Togo 2 (Psychoanalytic Development Integration2) (Co-supervisor of translation) and Seishin Bunsekiteki Shindan Mensetsu No Susumekata (How To Give Psychoanalytic Diagnostic Interviews) (Coauthor).