What Is Diagnosis? : Medicalization of the Children with Developmental Care Needs in Medical Checkups and Preschools in Japan

Background: A nationwide study reported that 6.3% of normal class students seemingly had developmental disorders. These students or children in Japan called as “kininaru-kodomo” or children with special care needs. However, there is no legitimate definition of children with special care needs. Therefore, its relationship with developmental disorders is ambiguous according to the professionals’ viewpoints. This study explores its definition through the hybrid model of concept development. 

Methods: The hybrid model is composed of a combination of literature review, fieldwork and analysis. The databases Japan Medical Abstracts Society (1983-2013) and Citation Information by NII (1991-2013) were systematically searched. Participant observation was conducted at multiple parent organizations. Moreover, narrative data was gathered through a key informant interview. These theoretical and fieldwork data were analyzed to hypothesize the relationship between the term’s concept and the presence of medical diagnosis. 

Results: A literature review revealed that medical professionals used the term of “kininaru-kodomo” as the synonym of children with developmental disorders. On the other hand, teachers of preschools and primary schools regarded them as children with troubles in group actions regardless of the presence of diagnosis. However, the tide of medicalization had occurred in schools and a public health nurse stated that preschool teachers asked municipalities to pick up the troublesome preschoolers as a possible case of developmental disorders at an infant medical checkup. In a medical professional’s perception, “kininaru-kodomo” was considered a children who could not be diagnosed because of their normal intellectual ability. Moreover, the distinction between “kininaru-kodomo” and normal children was considered blur.

Conclusion: The hybrid concept analysis demonstrated the arbitrariness of the application of the diagnosis of developmental disorders to children with special care needs. Making a common definition of “kininaru-kodomo” is necessary to keep any professionals from overlooking the care needs of children with or without developmental disorders.