Masaru Tateno

Aim: The Early Start Denver Model (ESDM), a core Naturalistic Developmental Behavioral Intervention (NDBI), promotes developmental gains in young children with autism spectrum disorder (ASD) through socially embedded learning. Because high‐intensity ESDM programs (approximately 20 h/week) are difficult to implement in many Japanese clinical settings, this study evaluated the effectiveness of a low‐intensity ESDM program using standardized assessments. Methods: A non‐randomized controlled design was employed with 47 toddlers aged 18–36 months with a confirmed ASD diagnosis. Thirty participants were allocated to the intervention group, while 17 participants were assigned to the control group and received treatment as usual. Unlike the original ESDM randomized controlled trial implementing approximately 20 h/week, the intervention group (ESDM group, n = 30) received 60‐min ESDM sessions once weekly for 24 weeks, with parents present during sessions. Outcomes were assessed before and after intervention using the Autism Diagnostic Observation Schedule‐2 (ADOS‐2), Kyoto Scale of Psychological Development 2020 (KSPD‐2020), and Vineland Adaptive Behavior Scales‐II (Vineland‐II). Results: Analysis of covariance ( ancova ) controlling for baseline scores revealed a significant group difference in the KSPD‐2020 all domains developmental quotient (DQ) ( p = 0.0416). Trend‐level differences were observed in the postural–motor domain ( p = 0.0811) and the cognition–adaptation domain ( p = 0.0555). No significant between‐group differences were found in the other outcome measures. Adaptive behavior showed modest increases in communication and socialization, although between‐group differences were not statistically significant. Conclusion: Although the original ESDM recommends intensive delivery exceeding 15 h per week for 2 years, the present findings provide preliminary evidence that a low‐intensity ESDM program—delivered once weekly for 24 sessions—can support meaningful developmental progress, even when changes in core autism symptoms are not detected after statistical adjustment in toddlers with ASD in Japanese clinical settings. These results highlight the feasibility of adapting ESDM principles to low‐intensity service environments and underscore their potential applicability within Japanese cultural and systemic contexts.

Aim: Questionnaire‐based screening tools for Internet Gaming Disorder (IGD) are widely used in clinical and epidemiological research. However, discrepancies between child self‐reports and parent reports may complicate the interpretation of screening results, particularly when cutoff‐based classifications are applied. Methods: Participants were 58 adolescents (aged 10–18 years) attending child and adolescent psychiatry outpatient clinics and their parents. Gaming‐related problems were assessed using parallel screening instruments: the Internet Gaming Disorder Scale for Children (IGDS‐C) and the Parental version of the Internet Gaming Disorder Scale (PIGDS). Parent–child agreement was examined using dimensional analyses (Pearson's correlation), paired comparisons (paired t ‐test with Wilcoxon signed‐rank test as a sensitivity analysis), and categorical agreement indices (concordance rate, Cohen's κ , and McNemar's test) based on the conventional cutoff score. Results: Parent‐ and child‐reported IGDS scores were moderately correlated ( r = 0.61, p < 0.001), indicating substantial dimensional concordance. However, parents reported significantly higher IGDS scores than children (mean difference = −1.09, p < 0.001), a finding confirmed by the Wilcoxon signed‐rank test. Categorical agreement based on cutoff‐based screening classifications was low ( κ = 0.16), with most discordant cases reflecting parent‐positive and child‐negative classifications. McNemar's test demonstrated a significant asymmetry in these discrepancies. Conclusion: Although parent and child IGDS scores demonstrate meaningful dimensional concordance, the application of fixed cutoff‐based screening classifications substantially reduces agreement, a pattern that may reflect differences in evaluative thresholds between informants. These findings highlight limitations of relying solely on self‐reported cutoff‐based measures and underscore the need for multi‐informant, dimensional approaches when interpreting IGD screening results in youth.

Aim: Attention‐deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by inattention (IA), hyperactivity, and impulsivity. In 2022, the Japanese version of the ADHD Rating Scale‐5 (ADHD‐RS‐5) was released based on DSM‐5. Although there are several changes compared to the previous version, few clinical studies have been conducted using the ADHD‐RS‐5. This study aimed to re‐evaluate ADHD‐related characteristics by age group in pediatric psychiatric outpatients, using the ADHD‐RS‐5 regardless of diagnosis, and compare these findings with previous research. Methods: Participants were all patients aged 5–17 years who visited the Psychiatry Clinic of Tokiwa Hospital or the Tokiwa Child Development Center (Child Psychiatry Clinic) during the study period. Of 503 children, 452 met the inclusion criteria. Primary caregivers completed the ADHD‐RS‐5. Symptom and functional impairment scores were compared by ADHD diagnosis and age group. In the ADHD group, scores were also compared based on pharmacological treatment. Results: IA and hyperactivity–impulsivity (HI) scores were significantly higher in the ADHD group. Functional impairment scores did not differ significantly in some age groups. HI scores were lower in older age bands, whereas IA scores did not differ significantly across age groups; the cross‐sectional patterns are compatible with relative stability of inattentive symptoms but do not establish longitudinal persistence. Pharmacological treatment was not linked to symptom scores but was associated with higher impairment scores. Conclusion: Our findings using the ADHD‐RS‐5 showed results consistent with previous reports regarding age‐specific symptom characteristics of ADHD, while also providing new insights into treatment options for ADHD. Clinicians may consider both symptom severity and functional impact when initiating pharmacotherapy. Given medication approval from age 6 in Japan, accurate assessment and diagnosis remain essential, and the ADHD‐RS‐5 may support decision‐making when interpreted alongside clinical judgment and multi‐informant input.

The post-discharge period following psychiatric hospitalization is a high-risk period for suicide attempts. This risk is substantially higher for patients

Adolescents with autism spectrum disorder (ASD) often have various psychiatric comorbidities, particularly depression. In recent years, gaming disorder (GD) and Internet addiction (IA) have been identified as common comorbidities of ASD. We administered three self-administered screening instruments to adolescents with ASD to assess the severity of depression, GD, and IA. The participants were 10–18-year-olds with ASD. They were asked to complete three questionnaires to assess depressive symptoms, GD, and IA: the Patient Health Questionnaire for Adolescents (PHQ-A), Ten-Item Internet Gaming Disorder Test (IGDT-10), and Internet Addiction Test (IAT). The total IGDT-10 score was calculated in two different ways: the original scoring version (IGDT-10-OV) and the modified version (IGDT-10-MV). Of the 74 respondents, 24.3% had moderate or severe depressive symptoms, 8.1% were identified as having possible GD according to the IGDT-10-OV, 39.2% were identified as having possible GD according to the IGDT-10-MV, and 27.0% were positive for IA according to the IAT. Two-group comparisons revealed that depressive symptoms were more strongly associated with IA than with GD. IA was associated with more depressive symptoms than GD. Since adolescents with ASD have difficulties with social communication, they are prone to isolation and feelings of loneliness. Longer screen times due to social isolation may be a risk factor for the development of GD/IA. Adolescents with ASD often exhibit a preference for visual processing but may struggle with verbal communication. Thus, they may find online spaces more comfortable for them to alleviate their feelings of loneliness.

Background: Gaming is a popular leisure activity among children and adolescents in Japan. Recently, gaming disorder (GD) has become a common issue in child and adolescent psychiatry. However, due to a severe shortage of child and adolescent psychiatrists (CAPs) in Japan, we hypothesized that young patients with GD and gaming-related problems may seek help at pediatric or general psychiatric clinics, which serve as primary care providers for children's mental health issues. In this study, we conducted a regional survey in Sapporo, Japan, to understand the current status of medical interventions for GD provided by pediatricians and psychiatrists. Methods: This was a cross-sectional survey conducted in a specific region of Japan. The subjects of this study were almost all pediatricians, psychiatrists, and CAPs practicing in Sapporo, Japan. A questionnaire was mailed to a total of 196 medical institutions. The survey included questions about clinical practices related to GD, such as experience in treating GD, common presenting symptoms in patients with GD, and psychiatric comorbidities associated with GD. Results were statistically compared between two groups: pediatricians and psychiatrists. Results: We received 60 responses, yielding a response rate of 30.6%. All collected response forms were considered valid, and only one response to the question about the percentage of patients with gaming-related problems was considered invalid because it was an outlier (answer of 80%). The rate of respondents who had encountered gaming-related problems was 53.8% (n=14) among pediatricians (n=26), 52.2% (n=12) among psychiatrists (n=23), and, as a reference, 81.8% (n=9) among CAPs (n=11). When asked about the proportion of patients with gaming-related problems among all the patients they had seen, pediatricians reported 0.6%, psychiatrists reported 2.9%, and CAPs reported 8.7%. Autism spectrum disorder (ASD) was the most commonly reported comorbid diagnosis associated with GD, followed closely by attention deficit hyperactivity disorder (ADHD). Depression and anxiety were the third most commonly reported comorbid conditions. Discussion: While many CAPs (81.8%) are already addressing gaming-related issues, only about half of pediatricians (53.8%) and psychiatrists (52.2%) are involved in such treatment. With the increasing number of children and adolescents engaging in online gaming, playtime has gradually increased, potentially leading to an increase in GD cases. The difference was that pediatricians were often consulted about somatic symptoms, while psychiatrists were typically required to manage behavioral issues, such as excessive spending on gaming, and psychiatric symptoms, such as anxiety. As the number of children and adolescents seeking medical care for gaming-related problems is expected to increase, it is anticipated that clinical guidelines will be developed to enable both pediatricians and psychiatrists to effectively manage these cases.

Aim: The aim of this study is to estimate the rate of patients who screened positive for gaming disorder (GD) in ICD‐11 among adolescents with psychiatric and/or developmental disorders by using two screening tests: a nine‐item screening test for GD, GAMing Engagement Screening test (GAMES Test), and the Ten‐Item Internet Gaming Disorder Test (IGDT‐10).Methods: Subjects were 257 adolescent patients attending a psychiatric clinic in Sapporo, Japan. They were asked to complete two questionnaires. The total score on the IGDT‐10 was calculated by two different scoring methods, original version (OV) and modified version (MV). The three groups were also compared on the basis of their clinical diagnoses.Results: Of the 203 respondents, 42 (20.7%) screened positive using the GAMES Test. With respect to the IGDT‐10, only eight (3.9%) screened positive using the IGDT‐10 OV scoring, while 55 (27.1%) screened positive using the IGDT‐10 MV. The most notable finding was that the mean total scores on the GAMES Test and the IGDT‐10 MV were significantly higher in the attention deficit hyperactivity disorder group than in the other two groups (depression and autism spectrum disorder).Conclusion: The results of this study showed that adolescents with mental health problems had a higher rate of screening positivity on self‐rated screening tools for GD than the general population. Because excessive gaming has a wide range of adverse effects on adolescents' mental health, early detection of probable GD is crucial. Screening for GD should be part of routine clinical practice.

The association between autism spectrum disorder (ASD) and gender dysphoria (GD) has attracted a great deal of interest among child and adolescent psychiatrists in Japan. In clinical settings, it is common to hear complaints or concerns related to GD from adolescents with ASD. In the past few years, several review articles have been published on ASD and GD. The Initial Clinical Guidelines for co-occurring ASD and GD in adolescents were published in 2018, suggesting the increasing need of intervention for these conditions worldwide. Although a large amount of evidence has been accumulated regarding the co-occurrence of ASD and GD, all review articles were based solely on case reports and articles published in English. In this article, we performed a bilingual literature review using English- and Japanese-language literature databases. We found 13 case reports in English and 11 case reports in Japanese. The Japanese literature included articles on gender-related symptoms in ASD, but not limited to ASD with comorbid GD. Wattel and her colleagues proposed 15 theories on the link between ASD and GD. We classified the reported cases into one or more of the fifteen theories proposed by Wattel. These theories seemed useful in understanding the co-occurrence of ASD and GD, especially in AMAB cases. Wattel’s 15 theories are categorized into biological, psychological, and social factors, respectively. With regard to the social factors, we discussed Japanese school culture and psychological burden among gender-dysphoric students. Further studies are awaited.