発達障害、自閉スペクトラム症、ADHDについて精神科医が徹底的に語ります。

What are developmental disorders? Unlike "intellectual disabilities," which are characterized by overall low intelligence, developmental disorders are characterized by significant variations in "ability" and "weakness." They are classified as ASD (Autism Spectrum Disorder), ADHD (Attention Deficit Hyperactivity Disorder), and LD (Learning Disabilities), but this article will focus on ASD and ADHD. Characteristics of ASD (Autism Spectrum Disorder) Difficulty reading between the lines and the atmosphere, and unable to distinguish between true feelings and pretenses. Hyperacusis, resulting in a strong reaction to sounds and prone to tantrums. Strongly attached to routines and prone to panic when disrupted. An imbalance between the brain's "excitatory system (glutamate)" and "inhibitory system (GABA)" is thought to be the root cause. There is no definitively effective medication, and symptomatic treatment, such as using antipsychotics or mood stabilizers to "lower the overall tone," is the primary treatment for tantrums. Environmental adjustments (reducing auditory stimuli, using visual information, etc.) are very important. Characteristics of Attention Deficit Hyperactivity Disorder (ADHD) The underlying cause is a disorder of attention and concentration allocation. The individual may focus entirely on one thing, or, conversely, be distracted. This often manifests as inattention (forgetfulness, poor organization), hyperactivity, and impulsivity (e.g., violent outbursts). Even if the individual has the ability (IQ), poor "work allocation" and "focus allocation" can lead to low evaluations. ADHD Neuroscience and Pharmacology It is believed that the function of dopamine and norepinephrine in the prefrontal cortex is weakened. Main Medications: Methylphenidate (Concerta) and Lisdexamfetamine (Vyvanse): Highly effective but poses the risk of addiction. Only registered physicians can prescribe. Atomoxetine (Strattera): Low addictive potential, mild effect, and slow onset. Guanfacine (Intuniv): Derived from a blood pressure medication, it has a relatively rapid onset of action. It's important to combine medication with environmental adjustments (reducing stimuli, incorporating game-like elements, etc.). Diagnostic Approach Developmental disorders are thought of as "innate irregularities" that become more pronounced, and are not illnesses that suddenly appear at an intermediate age. The key is whether the individual has had consistent characteristics since childhood. Tests (such as the AQ or WAIS) are merely tools for organizing the medical history, and the final diagnosis is made based on interviews and progress with a psychiatrist. We are cautious about labeling everything that's "a bit gray" as a disease. However, if you intend to receive welfare benefits such as disability pensions or disability certificates, it is important to have a proper diagnosis. Support and Treatment Key Points ASD: Reduce auditory stimuli and communicate specifically with visual information (text and email). ADHD: Create a low-stimulus environment and make studying and work easier to concentrate, such as by gamifying the environment. The core of treatment for both disorders is to prevent "secondary disorders" (depression and anxiety) caused by continually underestimating one's abilities. Tips for Visiting a Doctor Rather than asking for tests, it's actually more useful to ask your doctor, "Do you think there are any signs of ASD/ADHD?" It's perfectly fine to learn about these tendencies from books and online resources and incorporate strategies that work for you.