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Japanese research on ADHD is prolific, and clinical management of this condition in Japan takes place in one of the most accessible and efficient health care delivery systems in the world. It is therefore particularly instructive to examine differences in the identification, management, and social context of ADHD in Japan; ­ these differences can tell us much about the role of “local” cultural, po­ liti­ cal, and institutional forces in professional and popu­ lar perceptions of a global illness. As this subchapter shows, differences in the sociocultural and institutional context of ADHD in Japan lead not only to dif­fer­ ent experiences of illness among individuals, but also to dif­ fer­ ent choices about its management and treatment for parents and clinicians. Although rates of medi­ cation usage for ADHD are on the rise in Japan, they remain low by international standards (Scheffler et al. 2007). The classic formulation of Ritalin, emblematic of the rise of ADHD in the United States, is eschewed completely, and­there is evidence that clinicians and regulators alike have a preference for non-­ stimulant drug therapy. Medicalized understandings of the origins of ADHD symptoms do not seem to have removed the stigma associated with the diagnosis . ­ These differences in the medicalization of ADHD in Japan are particularly notable in the context of the country’s notoriously competitive, exam-­ based 13 ADHD in Japan A So­cio­log­i­cal Perspective Mari J. Armstrong-­ Hough 262   Global Perspectives on ADHD educational system and high levels of anxiety surrounding child and adolescent behavioral issues. This short subchapter responds to three related so­ cio­ log­ i­ cal questions about the rise of ADHD in Japan. First, and most broadly, how has the medicalization of ADHD progressed in Japan? Second, what is the nature of the stigma associated with ADHD in Japan, what are its origins, and how is it changing? And fi­ nally, how has the course of its medicalization and its changing association with deviance influenced the identification and treatment of ADHD in Japan? The Medicalization of ADHD in Japan Research on inattention has a long history in modern Japan. In the early twentieth ­ century, the founding ­ father of Japa­ nese psy­ chol­ ogy, Yuzero Motora, theorized inattention and described “ADHD-­ like symptoms” in his subjects (Takeda, Ando, and Kumagai 2015). Con­ temporary research on inattention is rooted in a long history of conversation and exchange with international research communities. Nonetheless, the following sections note several features of ADHD in Japan that may be less familiar to researchers outside the country: the relatively narrow rules set by the Ministry of Health, ­ Labor, and Welfare (MHLW) restricting ADHD diagnosis to ­ children, longstanding associations with autism spectrum disorder, the stigma attached to diagnosis, and cultural and institutional constraints on pharmacotherapy. Current official classifications of ADHD in Japan are narrow: symptoms are expected to emerge by 7 years of age (but cannot be treated ­ until ­ after age 6) and MHLW rules prevent diagnosis and treatment of the disorder ­ after 18 years of age. In line with international prevalence estimates, the MHLW estimates that between 3% and 7% of Japa­ nese ­ children are affected by ADHD and that the disorder disproportionately affects boys (MHLW 2015b). However, adult ADHD is not officially recognized, and no medi­cations from the narrow range of ADHD treatment options are indicated for adult ADHD. This has not necessarily prevented “off-­ label” prescriptions to help adults manage the disorder, but it does represent a significant institutional hurdle to diagnosis and treatment­ after age 18. A further notable feature of ADHD in Japan is its association with autism spectrum disorder through the umbrella term hattatsu shogai. Hattatsu shogai literally translates as “neurodevelopmental disorder.” The anthropologist Junko Teruyama cautions En­ glish speakers not to assume that the Japa­ nese term reflects the same classificatory schema that underlies its use in any version of the ADHD in Japan   263 Diagnostic and Statistical Manual of Medical Disorders (DSM). In Japan, the professional and popu­ lar use of the term hattatsu shogai to group together disorders related to autism, inattention, hyperactivity, and learning long predates the DSM classification and primarily emerged to distinguish ­ these disorders from intellectual disabilities (Tamekawa et al. 2014; Teruyama 2014). The term groups a wide range of disorders, from mild dyslexia to autism, together into a single category of “developmental disorder.” In part ­ because of this classification, ­ there is a longstanding perception among the general public that ADHD and autism spectrum disorder are cousin afflictions. Educational institutions and the...


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