Journal of Developmental Disabilities Research

CONTENTS
Original Article
Kai Seino, Yoko Enomoto and Shiho Miyazawa : Textual Requirements for High School Students with
Developmental Disabilities: Text Analysis About Assessing Educators and Employment
Support Professionals in Japan������������������������������������������������������������������������������������������������������ 1
Mami Shiratori, Michio Kojima and Motoko Igarashi : Relationship between Burnout, Mental Health,and Assertiveness among Nursery school teachers of Children with Special Needs������������������ 18
Paper

Shuhei Ogawa and Michio Kojima : Relationship between Contingencies of Self-Worth,Contentment of Sources of Self-Worth, and Subjective Well-Being of Japanese People with
Autism Spectrum Disorder���������������������������������������������������������������������������������������������������������� 38
Kotaro Kusaka, Soichi Hashimoto, Toshiaki Taketatsu and Aki Doyama : The “Sense of Difficulty”
Related to Developmental Disorders in Japanese High School Students: A Case Study ofa Yogo Teacher’s Experience������������������������������������������������������������������������������������������������������� 52
Takuya Miura, Soichi Hashimoto : Effects of Sub-Threshold Neurodevelopmental Traits on the
Adjustment of Female Students to High School: A Study Focused on Premenstrual
Dysphoric Mood�������������������������������������������������������������������������������������������������������������������������� 61

The Japanese Association for the Study of Developmental Disabilities

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1.

Editorial Rules

The Journal is the English-language official journal of the Association for the Study of Developmental Disabilities, and inprinciple, it publishes one volume per year online.
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The Journal reviews papers in the areas of developmental disabilities and related health, welfare, work, education, andpsychology.
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【Contact information】
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Japanese Association for the Study of Developmental Disabilities
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［Original Article］

Textual Requirements for High School Students with Developmental
Disabilities: Text Analysis About Assessing Educators andEmployment Support Professionals in Japan
Kai Seino

Department of Social Rehabilitation, Research Institute,
National Rehabilitation Center for Persons with Disabilities

Yoko Enomoto

Center for Promoting Education for Persons with Developmental Disabilities,
National Institute of Special Needs Education

Shiho Miyazawa

National Institute of Vocational Rehabilitation, Japan Organization for Employment of the Elderly,
Persons with Disabilities and Job Seekers

Abstract
Background: Individuals with developmental disabilities face various challenges in theireducational journey, which often vary as per their particular disability.
Aims: This study aimed to clarify how information presentation should be considered in text
teaching materials based on the characteristics of students with developmental disabilities.
Methods: 1. Creation of items to evaluate information presentation methods: As a preliminary
survey, a questionnaire survey was conducted by mail (November-December 2008) to collect openended comments on “how to present information for creating text materials for children (persons)with developmental disabilities.” Questionnaires were sent to 750 educational institutions and 550
employment support institutions in Japan regarding employment readiness support for persons
with developmental disabilities. The educational institutions were (A) regular high schools and (B)special needs schools in the upper secondary school stage. The employment support organizations
were (1) Public Employment Security Offices (in charge of employment for persons with disabilities),(2) Vocational Skills Development Centers for Persons with Disabilities, (3) Vocational Centers
for Persons with Disabilities, (4) Work/Life Support Centers for Person with Disabilities, (5)Support Centers for Persons with Developmental Disorders, (6) Employment Support Centers
for Persons with Disabilities, and (7) Employment Transition Support Offices for Persons with
Disabilities throughout Japan. The overall response rate was 33.9% (441 responses), and that for freedescriptions was 22.0% (n = 97). Based on the opinions (free descriptions) about text materials (n =97) identified in the preliminary survey, 30 items were created with reference to the KJ method. 2.Aquestionnaire survey was conducted by mail from February to March 2010 to understand how topresent information on developmental disabilities according to the characteristics of the disabilities.
The number of questionnaire responses was 374 (28.6% response rate). The characteristics of theinformation presentation method based on developmental disability characteristics were revealed
by a correspondence analysis and hierarchical cluster analysis. Respondents to the survey were
either teachers at educational institutions or support personnel at employment support agencies.
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Respondents had experience in providing employment support to persons with developmental
disabilities, and based on their experience, they recalled the general disability characteristics of LD,
ADHD, and ASD and responded to the information presentation methods that they considered mostimportant for each of these disabilities. Respondents also responded only to the disability types (LD,ADHD, and ASD) to which they could respond.
Results: To understand the considerations regarding information presentation based on thecharacteristics of developmental disabilities, a correspondence analysis and hierarchical cluster
analysis using the dimension score of the correspondence analysis were carried out (n = 173). The
information presentation method considered each developmental disability (LD, ADHD, and ASD)
and was classified into three groups. A correlation analysis was carried out on the relationshipbetween disability characteristics (LD, ADHD, ASD), and each item (30 items) of the information
presentation method was classified into the same group as each obstacle (n = 173). A significant
correlation was found between the characteristics of each developmental disability and theinformation presentation method. Text mining was applied to the free description responses (LD: n =114; ADHD: n = 152; ASD: n = 159). After the extraction of characteristics, sentences were identified
containing characteristic words that indicated the considerations necessary for each disability type.
For LD, “illustration,” “ruby,” and “picture” were extracted as characteristic words, and the contentsof sentences indicated that the use of these words was cited as a device. For ADHD, “information,”“short,” and “many” were extracted as characteristic words, and the contents of sentences indicatedthat not increasing the amount of information and expressing it in short sentences were cited as
devices. For ASD, “concrete,” “necessary,” and “content” were selected, and the content of thesentences showed that explaining specific examples of the content was cited as a device.
Conclusions: This study clarified supporters’ consideration of the information presentation ofteaching materials according to the characteristics of students with developmental disabilities.
Keywords: developmental disabilities, autism spectrum disorder, information presentation, text
teaching materials, text mining

1.

Introduction

1.1

What this paper adds?
For persons with disabilities, working is an important aspect of social participation andeducation is where students with disabilities acquire skills before entering the workforce. In learning
situations, information is often presented as digital materials or paper texts. This study provides
useful suggestions by clarifying the findings of practitioners who provide support in these situations.
Previous studies report that developmental disabilities contribute to cognitive disabilities (Bromanand Grafman, 2014) the degrees of which vary across developmental disorders (Kanai et al., 2012;
Kanai et al., 2017). By clarifying how to present information so that it considers the characteristics
of different developmental disorders, this study contributes to improving the learning effectivenessof persons with developmental disorders. Key attributes improving text comprehension (McTigue
and Slough, 2010) and methods of information presentation for individuals with learning disabilities(Waight and Oldreive, 2021) have been studied. However, previous studies look at a single disorder,
neglecting to compare disorders. Additionally, effective items were within the questionnaire set byresearchers, and may not reflect unexpected content. Therefore, this study investigated ASD, LD,
and ADHD. Further, to effectively reflect the experiences of practitioners in the data, we collected─2─Journal of Developmental Disabilities Research No. 1

data through free descriptions. Therefore, we add the cognitive characteristics of information foreach developmental disability disorder and effective methods of information presentation, reflecting
practical knowledge based on the experiences of practitioners of employment and education.
1.2

Brief overview of Japanese laws regarding persons with developmental disabilities
Learning disabilities (LD), attention-deficit hyperactivity disorder (ADHD), and autism spectrum
disorder (ASD) were classified as developmental disabilities in Japan in 2005. The Act on Support for
Persons with Development Disabilities was enforced in 2005. This act recommends support basedon the characteristics of the obstacles persons with developmental disabilities face and the life stagesof persons with such disabilities. The characteristics of the disabilities that are covered by this law
are as follows: persons with LD have poorer calculation, writing, and reading abilities than those withtypical intellectual development; the characteristics of ADHD include inattention, hyperactivity, andimpulsivity; and the characteristics of high-functioning ASD are communication barriers, lack ofinterpersonal and social skills, patterned behavior, and wavering interest (Ministry of Health, Labourand Welfare, 2008). The Act on Support for Persons with Development Disabilities was revisedin 2016. The revised law strengthened the conditions of providing appropriate educational andemployment support based on the characteristics of these developmental disabilities. In the future, it
is important to provide the support necessary for smooth transitions from education to employment
based on the characteristics of an individual’s developmental disabilities.
1.3

Issues Related to Transition to Employment for persons with Developmental Disabilities: on
Textbooks to Support Work ReadinessIn recent years, the difficulty of transitioning from school education to employment has become
an issue for individuals with developmental disabilities such as LD, ADHD, and ASD. One of the preemployment problems is the difficulty in choosing a career path suitable for them (Japan Parents’
Association of Learning Disabilities, 2008), while another is separation from employment due tomaladjustment in the workplace (National Institute of Vocational Rehabilitation, 2009; 2015).
In order to cope with such pre- and post-employment issues, it is important for students todeepen their understanding of such important aspects of work as social structure and occupational
information (job understanding) and their understanding of themselves, such as their interests inwork and their strengths and weaknesses (self-understanding), before they graduate from school, as
these are fundamental for employment.
In addition, when providing career guidance to strengthen the job understanding of students
with developmental disabilities, it is necessary to provide a wide range of information on suchmatters as vocational rehabilitation, a variety of career options including employment for persons
with disabilities, and the differences between general employment and employment for persons withdisabilities. As the amount of information to be provided has increased, it is necessary to provide
information not only orally, but also in the form of textbooks (on paper). Under these circumstances,
it is necessary to consider how to convey the information in the text in an easy-to-understandmanner, taking into account the characteristics of disabilities. Accordingly, this study focuses on“employment” texts.
1.4

Disability Types and Cognitive Functioning Disorders in Developmental Disorders
Students with developmental disabilities face various challenges when seeking employment.
Individuals with reading difficulties may face obstacles in comprehending and completing
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employment-related materials. According to Broman and Grafman (2014), developmental disorders,such as ASD, contribute to cognitive impairment. Cognitive dysfunction negatively impacts reading,as reading requires short-term language memory (Castles et al., 2014). It has been reported thatthe degree of disability in such language memory varies depending on the disease; that is, verbal
memory is high in Asperger’s syndrome and low in other pervasive developmental disorders (Kanai
et al., 2012). Cognitive functions other than verbal memory also differ depending on the disorder.
Adults with ASD have higher language comprehension than adults with ADHD when evaluatedby the Wechsler Adult Intelligence Scale-Third Edition (Wechsler, 1997), but the latter have higher
picture completion skills (Kanai et al., 2017). In other words, since the characteristics of cognitive
function differ depending on the disorder, the effective information presentation method should differ
accordingly. Consequently, adults with ASD have lower language comprehension and higher painting
skills than adults with ADHD (Kanai et al., 2017).
1.5

Issues related to reading materials and text presentation
The following are some of the ways in which textbooks are used in education. The authors of
the current study focused on text teaching materials regarding employment for students (persons)with developmental disabilities. In the field of education, text teaching materials have been examinedfrom the perspectives of plainness, ease of remembrance, and motivation. Specifically, previous
studies have identified the following ways to increase users’ understanding: including illustrations
related to the written content (Larkin and Simon 1987; Mayer et al., 1995; Shimada and Kitajima,2008); specifying the structure of training material contents, such as paragraphs and items, (Seki,
1997); and finally, providing titles for teaching materials and using illustrations and colorization toincrease learners’ motivation (Shimada, 2016).
Aside from these ways, the characteristics of developmental disabilities need to be considered,
one reason being to create simpler specifications for students with developmental disabilities. The
importance of providing teaching materials that consider the characteristics of developmental
disabilities is that they guarantee information accessibility for persons with disabilities in the field of
education. A previous study reported that it is important to consider the difficulty in finely adjustingeye movements for individuals with LD, impulsivity, and carelessness for individuals with ADHD,
and the promotion of understanding through visual representation for individuals with ASD (Ministryof Education, Culture, Sports, Science and Technology, 2011). However, these simple examples
do not sufficiently clarify the overall perspective on this issue. In the future, it will be necessary
to accumulate basic knowledge. Specifically, text teaching materials should be developed whileconsidering the characteristics of individuals with developmental disorders.
The following are some studies on the reading comprehension of persons with developmental
disabilities. According to Hoover (2011), colored text is more effective than black and white text
in presenting information to students with ADHD. In addition, there are reports that the use ofgraphic organizers is effective in presenting information to students with Asperger’s syndrome.
Research that focused on the reading comprehension abilities of students with ASD was reviewed(Singh et al., 2021). Effect size calculations indicated that visually cued instruction, metacognitive
strategy instruction, and adapted text were highly effective, while collaborative strategies andtechnology-assisted instruction were moderately effective. This study highlights the effectivenessof visually cued instruction and adapted text in enhancing reading comprehension among students
with ASD. In addition to graphic organizers, visual cues help students with high-functioning ASD
process reading materials (Stringfield et al., 2011). Although some studies have examined the impact
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of graphic organizers and technology-enhanced reading materials on learning among students
with developmental disabilities and other studies have examined differences in processing textual
information, there is less work regarding the ways to specifically present reading materials to persons
with developmental disorders.
We highlight one study that indicates that text design is actually more important thantechnological enhancements; future studies could further test that finding. The significance ofdevising ways to present information in teaching materials is as follows. A survey of children withlearning disabilities suggested that it would be effective to present both digital and paper materials
to children with or without disabilities (Marino et al., 2014). There has also been research on online
texts. Rello et al.’s (2012) experiment using online textbooks for persons with dyslexia showed which
fonts and backgrounds, colors, font sizes, spacing (characters, rows, paragraphs), and column widths
improved readability for persons with dyslexia. That is, sentences and figures are also displayed inelectronic teaching materials. Therefore, the knowledge derived from this research can be used to
improve the readability of electronic teaching materials. According to McTigue and Slough (2010),
the main attributes that improve text comprehension are (a) text specificity, (b) the author’s voice, (c)consistent descriptive structure, (d) selective use of visual information, and (e) integrated language
and visual information. Further, Waight and Oldreive (2021) posit that it is important to consider
the use of language, image, audio, and video in developing accessible information for individuals
with learning disabilities. The use of clear and jargon-free language is also important (Waight andOldreive 2021). Finnegan et al. (2016) integrated the results of previous studies and ascertained that
direct instruction and graphic organizers positively affect reading comprehension for individuals
with ASD. They also found collaborative learning, anaphoric queuing, and question generation to bepromising.
However, electronic text does not affect reading comprehension. Even online and electronic
books need to present the text in an accessible way. For this reason, as well as the fact that the mainteaching materials for students with disabilities in Japan are printed, the current study focuses on
print, (paper-based) materials. Furthermore, this study is highly relevant in today’s scenario because
there are still many teaching materials that are mainly printed on paper in some areas of the world.
The cognitive functions involved in human information processing are important for both paper anddigital teaching materials.
1.6

Focus on high school students with developmental disabilities who are about to enter theworkforce
The Report of the Expert Group on Special Needs Education in the New Era (Ministryof Education, Culture, Sports, Science and Technology, 2019) points out that students with
developmental disabilities “have difficulty adjusting to their environment and building relationships
with others, and drop out of school or resign from their jobs, and become isolated from society. In
some cases, they have difficulty adjusting to their surroundings or have trouble building relationships
with others, and drop out of school or leave the company, leaving them isolated from society.” Thereport also points out that “in addition to employment in the general framework, it is also possible
to obtain a disability certificate and use the so-called ’employment framework for the disabled,’ so it
is necessary to understand how to deal with these systems and provide appropriate guidance andsupport accordingly.” Under these circumstances, we considered it important to provide students
with developmental disabilities with a wide range of information in an easy-to-understand mannerat the upper secondary school level in order to enhance their future employment opportunities. As
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Journal of Developmental Disabilities Research No. 1

a methodology to achieve this, we believe it is necessary to focus on text materials (information
provided on paper), giving consideration to the characteristics of students with developmental
disabilities.
1.7

Study objectives
Taking into account the discussion in the previous section, this study aimed to clarify theconsideration of information presentation in text teaching materials based on the characteristics ofhigh school students with developmental disabilities. Subsequently, the authors examined informationthat was particularly important according to the characteristics of LD, ADHD, and ASD. Therefore,
this study is the first step in examining accessible texts in both printed and online media forstudents with developmental disabilities. Overall, the findings of this study are equally applicable todigital text and printed text.

2.

Materials and Methods*1

2.1 Item creation for the information presentation method
2.1.1 Preliminary study
As a preliminary study, a survey was used to collect responses regarding the information
presentation of text teaching materials developed for students with developmental disabilities
through free description. The survey was conducted by mail using a questionnaire (November–
December 2008) as part of the study reported in Terada (2006). Questionnaires were sent to 750
educational institutions and 550 employment support institutions in Japan. The former included
1) regular upper secondary schools and 2) departments of special-needs schools that fall under
the upper secondary school stage. The employment support organizations comprised (1) Public
Employment Security Offices (in charge of employment for persons with disabilities), (2) Vocational
Skills Development Centers for Persons with Disabilities, (3) Vocational Centers for Persons
with Disabilities, (4) Work/Life Support Centers for Person with Disabilities, (5) Support Centers
for Persons with Developmental Disorders, (6) Employment Support Centers for Persons with
Disabilities, and (7) Employment Transition Support Offices for Person with Disabilities throughout
Japan.
The response rate for the preliminary survey was 33.9% (number of questionnaires sent: 1,300;
number of questionnaires collected: 441). The response rate for the free description was 22.0% (numberof effective answers: 97).
2.1.2 Creation of evaluation items for information presentation methods
Thirty evaluation items of information presentation were developed based on the opinions(free descriptions) about text materials (n = 97) collected in the preliminary survey (Table 1),
and categorized with reference to the KJ method (Scupin, 1997). This method aggregates databy categorizing and naming it according to its content. This method was chosen because it issuitable for creating item content that reflects qualitative data. In addition, regarding the wording,a checklist about the information presentation method was being referred to while creating text
teaching materials for teachers (Enomoto et al., 2016).  In creating the items, the 15-item perspective
on how to include information in texts presented in Terada (2006) was used as a reference. The
categorization process was discussed by two researchers with knowledge of the subject matter ofthis study. Specifically, one was a researcher in psychology and the other a researcher in education
specializing in the area of employment support for developmental disabilities.
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Table 1

Information Presentation Method

LABEL

LABEL

1

A design that will prompt users to pick it up and read it

2

A design that is easy to read3

A design that makes it easy for a user to understand the content

4

A design that makes it easy to figure out which information is placed where5

Terms such as disabilities (or disorders) are handled considerately

6

The structure of the information is simple

7

The objective of the teaching materials is stated clearly8

It is written in plain sentences

9

A design that considers the pride of the user

10

A design that makes it easy to understand important points

11

Information is presented in a reliable form

12

A design that makes it easy for a user to utilize the information

13

Charts, illustrations, photographs, and flow charts are utilized effectively

14

A design that can be easily filled with information

15

Contents that a user can relate to16

Contents that help solve the problems of the user are selected

17

The sentences are engaging

18

Grammatically correct sentences are used

19

Many examples that can serve as a reference for a user are selected20

An appropriate quantity of information is included in one book21

The information provided has a consistent structure

22

An appropriate quantity of information is included on page 1

23

The purpose and method of usage are stated clearly24

A design that makes it easy to understand contents

25

A design that makes it easy for a user to make plans

26

A design that makes it is easy to find the required information

27

Charts, illustrations, photographs, flow charts, and so on are created correctly

28

Information is not misleading

29

Characters and terms are used appropriately

30

A design that is easy to handle

2.2

Survey participants
As part of this survey, we investigated how information is presented according to the disability
characteristics of developmental disabilities. A questionnaire survey was conducted by mail (February
to March 2010) targeting all regions of Japan. Questionnaires were sent to 750 educational institutions
and 556 employment support institutions. The educational institutions were “educational institutions
for students at the high school stage,” which are departments that fall under the high school stageof regular high schools or special needs schools, while the employment support institutions werebasically “employment support institutions for developmentally disabled persons” who have alreadygraduated from high school. The educational institutions specifically targeted were the same typesof institutions as in the preliminary survey. Respondents were either teachers at the educational
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institutions or support personnel at the employment support agencies. Each institution was asked to
select one respondent most appropriate for the purpose of this survey.
The participants were informed that, by responding to the survey, they were considered tohave consented to participating. Informed consent was obtained from all respondents. The study wasapproved by National Rehabilitation Center for Persons with Disabilities Ethical Review Committee.
The study was conducted in accordance with ethical standards as specified in the 1964 Declarationof Helsinki and subsequent amendments or equivalent ethical standards.
2.3

Survey procedure
In this study, we analyzed a part of that survey; the actual questions are shown at the end of
this paragraph. We focused on the content of the free text, and decided to examine the presentationof the text information. This study examines a survey used for a qualitative study we conducted ten
years ago because the recent development of text mining software has made new analysis possible.
Since human cognitive functions are unlikely to change significantly over the course of a decade, thisstudy is still significant today.
In addition, with the development of information science and technology in recent years, text
mining software that analyzes language quantitatively has become widespread. This made it possible
to perform a mixed analysis entailing quantitative analysis of qualitative data, which was difficult at
the time of the survey.
The self-report questionnaire concerned the development of text teaching materials for
employment-preparation training of high school students with developmental disabilities andwas constructed in a free description and selective style. This study analyzed responses to theinformation presentation method based on the characteristics of each developmental disability (LD,ADHD, ASD) that was part of the questionnaire. The concrete question items were:1) The most important item among the 30 items of the information presentation method for LD,
ADHD, and ASD: selective answer (Table 1)2) Concrete information to create teaching materials considering point 1 (the most importantitem): free description answer
In the overall survey, respondents responded only to the disability types to which they
were able to respond, given their experience in providing employment support to persons with
developmental disabilities. Respondents were included in the analysis where they had indicatedthat they had direct support experience with any parties with LD, ADHD, or ASD (including thosesuspected of having such). The support experience is as follows. Respondents were those who
answered “quite a bit” or “a little” with respect to “experience providing support to persons with (orsuspected of having) LD, ADHD, or ASD developmental disabilities in preparation for employment.”
Based on their experiences, the respondents were asked to recall the overall characteristics of eachdisability ─ LD, ADHD, and ASD ─ and the most important issues for each, along with the reasons
why they considered them most important. As a result, the responses represent a synthesis of the
respondents’ overall experience to date with regard to each of the disability characteristics of LD,
ADHD, and ASD. Regarding diagnosis, responses were sought not only from those with a diagnosis
of developmental disability, but also from those receiving support due to suspicion of a developmental
disability.

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2.4 Analysis methods
2.4.1 Selective type answer
Using correspondence analysis and cluster analysis, the information presentation method
according to the characteristics of developmental disabilities was explored. Moreover, to check theabsolute relationship between categories, a correlation analysis (φ coefficient) was conducted, andthe existence and strength of the correlation were investigated.
2.4.2 Free description type answer
The free description responses were used to more concretely understand the selective typeanswers. Therefore, text mining was applied to the free description responses.
2.4.3 Statistical software
SPSS Statistics (Ver 24.0) was used to conduct the Mann-Whitney U test and hierarchical cluster
analysis of the selective type answers. For the correspondence analysis of the selective type answers,
the statistics analysis software HAD was used. KH Coder 3 was used for the text mining of the freedescription answers.

3.

Results

3.1

Number of responses and response rate
The number of questionnaire responses in the final investigation was 374 (response rate: 28.6%).
The number of educational institutions that responded was 197 (response rate: 26.3%). The numberof employment support institutions that responded was 168 (response rate: 30.2%). The number of
responses that did not specify the type of institution was 9. The numbers of responses and response
rates by institution are shown in Table 2. However, effective responses differed for each analysis.

3.2 First-line information presentation method
3.2.1 Method 1
To understand the consideration of information presentation based on the characteristics ofdevelopmental disabilities, a correspondence analysis and a hierarchical cluster analysis using thedimension score of the correspondence analysis were conducted of the data for 173 respondents.
Specifically, the data were for responses for all disability characteristics (LD, ADHD, and ASD)
regarding the method of information presentation that was considered most important.
3.2.2 Result 1
The consideration of information presentation as per the characteristics of each developmental
disability (LD, ADHD, and ASD) differed according to the results of the analysis. In addition, theinformation presentation method considered each developmental disorder and was classified into
three groups (Figure 1).
Specifically, the results of the correspondence analysis of the multiple-choice responses showedthat each disability type (LD, ADHD, ASD) was clearly identified as a separate group on the twodimensional arrangement chart, and the cluster analysis results showed that each disability typegroup was defined by the respective following items: the LD group: 2. “easy-to-read design,” 7. “thepurpose of the material is clearly stated,” 17. “the text is attractive,” and 18. “grammatically correctsentences are used”; the ADHD group: 1. “the design makes the user want to pick up and readthe material,” 3. “the content is easily understood by the user: Design makes it easy for users tounderstand the content,” 4. “design that makes it easy for users to know which information is locatedwhere,” 5. “treats terms such as ’disability’ with consideration,” 15. “content that users can relate
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Table 2
Iinstitution

Number of responses and response rate per institution
Number of
responses(Response rate)

Classification of educational institutions

Iinstitution

Number of
responses(Response rate)

Classification of employment support institutions

High school98（26. 2 ％）Public employment security office (incharge of employment for persons withdisabilities)

35（9. 4 ％）High school stage of
special needs schools

99（26. 5 ％）Vocational skills development center for
persons with cisabilities,

13（3. 5 ％）Vocational centers for persons withcisabilities,

17（4. 5 ％）Classification of high schools
Full-time, General Course

62（16. 6 ％）Work/life support centers for personwith disabilities

39（10. 4 ％）Full-time,
specialized courses

25（6. 7 ％）Support centers for persons with
developmental disorders35（9. 4 ％）Distance learning,credit-based system

3（0. 8 ％）Employment support center for personwith disabilities

4（1. 1 ％）Part-time (Evening)8（2. 1 ％）Employment transition support office for 25（6. 7 ％）person with disabilities

Classification of special needs schools
High school for special needs

88（23. 5 ％）Special support schools forhigher education

10（2. 7 ％）None specified

1（0. 3 ％）to,” 24. “design that makes it easy to understand the content,” and 25. “design that makes it easy forusers to plan”; and the ASD group: 9. “designed with user pride in mind,” 11. “provides information
in a reliable manner,” 16. “content has been selected to address user concerns,” 21. “information
provided has a consistent structure,” 27. “charts, illustrations, photos, flowcharts, etc., are correctly
prepared,” 28. “information is not misleading,” and 29. “text and terminology are used appropriately.”
3.2.3 Method 2
The characteristics of the information presentation method based on the characteristics ofdevelopmental disabilities were revealed by Result 2 of the correspondence analysis and hierarchicalcluster analysis. To check whether the relationship was statistically significant regarding theinformation presentation method, the following analysis was conducted. A correlation analysis was
carried out on the relationship between disability characteristics (LD, ADHD, ASD) and each item (30items) of the information presentation method was classified into the same group as each obstacle (n= 173).
3.2.4 Result 2
A weak correlation was found between LD and “A design that is easy to read” (φ = .305, p <.001), “A design that makes it easy to understand important points” (φ = .160, p < .001), and “effective
utilization of diagrams” (φ = .250, p < .001). Next, a weak correlation was found between ADHD and “A
design that will prompt users to pick it up and read it” (φ = .170, p < .001), “amount of informationin one volume” (φ = .112, p = .01), and “ease of understanding contents” (φ = .113, p = .01). Finally,─ 10 ─

Journal of Developmental Disabilities Research No. 1

Figure 1

The results of a correspondence analysis of the selective type answers for the first-line
information presentation method (the dotted line represents a group based on the results of acluster analysis).

a weak correlation was found between ASD and “handling words such as ’disability’ considerately”(φ = .112, p = .01), “simple structure of information” (φ = .158, p < .001), “consideration of the user’s dignity” (φ = .176, p < .001), “information that is useful for problem solving” (φ = .228, p < .001),“consistent structure” (φ = .187, p < .001), “accuracy of diagrams” (φ = .141, p = .001), and “using
characters and terms suitably” (φ = .116, p = .01). A significant correlation was found between
the characteristics of each developmental disability (LD, ADHD, and ASD) and the information
presentation method. Accordingly, the relationship between each disability characteristic and theinformation presentation method was statistically significant.
3.3 Difference in concrete consideration by disability characteristic
3.3.1 Method 3
The statistical relationship between the obstacle characteristics and some selective type answers
to the first-line information presentation methods was examined. Based on this, the authors decided
to devise an effective plan for the actual information presentation method. To this end, text mining
was applied to the free description responses (LD: n = 114; ADHD: n = 152; ASD: n = 159). To createteaching materials based on the free description responses of those with experience in support fordevelopmental disabilities, the necessary matter was discussed concretely.
3.3.2 Result 3
The authors decided to clarify the differences in the discussed matter to consider characteristics
according to disability type. Therefore, the free description answer on the necessary device was─ 11 ─

Journal of Developmental Disabilities Research No. 1

Table 3
LD

Jaccardcoefficient

Disability Characteristic Words
ADHD

Jaccardcoefficient

ASD

Jaccardcoefficient

Illustration. 065

Information. 040

Consider. 066

Character

. 060

Short

. 036

Concrete. 054

Understanding

. 055

Many

. 035

Necessary. 054

Sentence

. 054

Point

. 032

Content

. 052

Size

. 051

Supporter. 032

Photograph. 044

Consideration. 045

Amount ofInformation. 028

Expression

. 036

Ruby

. 042

Time

. 024

Many

. 035

Teaching
Materials. 041

1 page. 023

Explanation. 032

Photograph

. 039

Think

. 023

Case

. 032

Comprehend

. 036

Form

. 023

Form

. 027

Note. LD, learning disabilities; ADHD, attention-deficit hyperactivity disorder; ASD, autism spectrum
disorderanalyzed. The Jaccard coefficient was computed to quantitatively clarify the difference arisingfrom disability type. The authors extracted ten words with a high Jaccard similarity coefficient
to represent each obstacle (Table 3). Then, the authors examined the sentences containing theextracted words and analyzed the contents of each sentence (Table 4).
For LD, the feature words “Illustration,” “Character,” “Understanding,” “Sentence,” “Size,”“Consideration,” “Ruby,” “Teaching Materials,” “Photograph,” and “ Comprehend” were extracted.
The content of sentences containing feature words indicated the following as textual innovations.:“Use materials that can be understood without text,” “Use illustrations and photographs,” “The sizeof a character: Suitable size of a character, figure, and ruby,” “A color and a feel,” “Line is changed,”“Unfilled space and contrast,” “An itemized formis used,” “Electronization of a textbook,” “Assumed
for upper elementary grades,” and “Addresses reading, writing, and math disabilities; different design(a display in white, character style, etc.) with the same teaching materials is applied.”
For ADHD, “Information,” “Short,” “Many,” “Point,” “Supporter,” “Amount of Information,” “Time,”“1 page,” “Think,” “and “Form” were extracted. The content of sentences containing feature words
indicated the following as textual innovations.: “Design the text to be organized, structured, and easy
to find without increasing the amount of information,” “Use short sentences,” “Keep it simple andeasy to understand,” “Use bold text,” “Use bullet points,” “Be direct or specific,” “Provide a comments
section,” “Make the text so that the reader can get a sense of accomplishment in a short time,” “Makethe first page of the talk a one-page summary; complete it on one page,” “Data that can help consider
what you should do,” and “Composition made with intuitive vision, such as color and form, reliance.”
For ASD, “Consider,” “Concrete,” “Necessary,” “Content,” “Photograph,” “Expression,” “Many,”“Explanation,” “Case,” and “Form” were extracted as feature words. The content of sentences
containing feature words indicated the following as textual innovations: “Explain by showing specificexamples,” “Use photographs, an example in question-and-answer format, or flowcharts,” “Use simple
and easy-to-understand expressions,” “Avoid negative expressions and increase positive content anddata from the survey,” “Use a clear and concise format. Use simple, easy-to-understand expressions,”“Avoid negative expressions,” and “Increase positive content and surveyed data.”
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Journal of Developmental Disabilities Research No. 1

Table 4
Disability

LD

Examples of sentences for Each Characteristic Word

Extraction word

Outline of the contents in a sentence

Illustration, Character,Photograph, Understanding,Sentence

Text that can be understood even if there is neither a character
nor a sentence is used.
To make a character and a sentence empathic, a suitableillustration and photograph are used.
The size of a character.

Sentence, Ruby

An itemized statement is used. The level of elementary school
upper classes is used.

Size, Ruby

Suitable size of a character, figure, and ruby.

Consideration

A color and a feel.
A line is changed.
Unfilled space and contrast.

Teaching materials,
Comprehension

The teaching materials of the contents correspond to thedisability with respect to reading, writing, and arithmetic. A
different design (a display in white, character style, etc. ) withthe same teaching materials is applied.
Electronization of a textbook (teaching materials and sentence).

The amount of information is limited and arranged.
Information, Many, Amount The flow of information is structured.
of information Short
A design that makes it easy to find information.
Direct expression in a short sentence.
ADHD

ASD

Point

It is intelligible.
It is simple. A bold letter is used.
An itemized statement is used. A concrete expression is used.

Supporter

While parents and a supporter communicate, a comment field
is prepared so that problems can be dealt with and organizedTime

Time is controlled. The text is written in a way that a sense ofaccomplishment is acquired in a short time.

Page 1

It summarizes the talk on the 1st page. It is complete on page
1 and is not connected to the next page.

Think

Data that can help consider what you should do, checking
feelings and actions.

Form

Composition made with intuitive vision, such as a color and aform, reliance.

Concrete, Necessary,
Explanation Photograph,
Content

According to various scenes, a concrete example is necessary.
It enables understanding the contents with a photograph.

Expression

Simple and clear expression.
Negative expressions are avoided.

Many

Affirmative contents are increased.
The data investigated are increased.

Case

An example in question-and-answer format.

Form

A flow chart is used to make it easy for the user to obtainrequired information.

Note. LD, learning disabilities; ADHD, attention-deficit hyperactivity disorder; ASD, autism spectrum
disorder─ 13 ─

Journal of Developmental Disabilities Research No. 1

4. Discussion
This study examined the consideration of effective information presentation of text teachingmaterials based on the characteristics of students with developmental disabilities. First, theconsideration of information presentation by a supporter by each obstacle classification was clarified
quantitatively and statistically.
The relationship between each obstacle characteristic and the consideration of information
presentation was ascertained. Next, to clarify the contents of the information presentation
method, text mining was applied to the free description responses about the concrete matter ofteaching materials that considered each obstacle characteristic. Further, the word characteristics
of each disability were quantitatively extracted. Subsequently, the typical and concrete methodof information presentation was arranged by reading and comprehending each sentence basedon the results. We showed that effective information presentation differed according to disability
classification through qualitative and quantitative analysis based on the participant’s thoughts.
However, regarding the evaluation of disability type and the effect, there is a limitation due to thesubjectivity of the supporter who provided the response.
In line with a supporter’s idea, the following is suggested based on the results of the correlation
analysis, or characteristic word extraction and sentence reading comprehension. Regarding LD, “easeof reading” content on devices, such as “ease of understanding a point” and “effective utilization ofdiagrams” is critical. Further, teaching materials that consider various factors, such as “the size of acharacter,” “use of an illustration and a photograph,” and well-designed “intelligibility of a sentence ora character” are needed. Regarding ADHD, intelligibility (for example, a design that requires reading
information in one volume) and ease of understanding the contents are required. Further, “shortening”
of sentences, not being made to increase the information, ease of understanding important points,
and information on page 1 are needed. For ASD, the following factors were considered important:accuracy, consideration of feelings, handling the word “disability” considerately, consideration of
the user’s dignity, structure of information, consistency of the information structure, accuracy of
diagrams, a suitable way of using characters and terms, and information that is useful for problemsolving. The findings of this study regarding the consideration and use of effective information
presentation methods for children with developmental disabilities by supporters are in line with thoseof previous studies. They correspond to the results of previous research on text teaching materials,
such as illustrations (Larkin and Simon, 1987; Mayer et al., 1995; Shimada and Kitajima, 2008), clear
statements (Seki, 1997) about the contents of teaching materials, illustrations and photographs, andcolorization (Shimada, 2016). From this, it is suggested that the information presentation method
for text teaching materials generally used is effective for persons with developmental disabilities.
Moreover, in this study, consideration corresponding to the finer needs of each disability wassuggested. Therefore, in the future development of teaching materials, it may be useful for support
providers to consider information presentation corresponding to each disability characteristic.
This study highlights the importance of selecting characters, figures, photographs, and so on,
tailored to each disease, as well as the specific content, format, and amount of information. This isconsistent with the general text comprehension elements suggested by McTigue and Slough (2010): (d)selective use of visual information, and (e) language and visual information. Concurrently, it reinforces
the importance of more specific content.
Moreover, this study shows the effects of using illustrations, photographs, ruby, colors,
digitization, and so on, for learning disabilities. This information considers the use of elements for─ 14 ─

Journal of Developmental Disabilities Research No. 1

learning disability information in Wait et al. (2021). In addition, this study embodies the clear andnon-technical language pointed out by Wait et al. (2021) as follows. In other words, the writing shouldreflect the upper elementary school level. Furthermore, this study demonstrates that photographs,
concrete examples, flowcharts, question-and-answer formats, and simple, straightforward, andpositive expressions are effective for students with ASD. This is consistent with the graphicorganizer found to be effective in Finnegan et al.’s (2016) study of ASD reading comprehension. It
is also congruent with and reinforces the promising anaphoric queuing and question generation byFinnegan et al. (2016). However, no promising collaborative learning was identified. In addition, no
electronic text was found to be ineffective. Based on the findings of Marino et al. (2014) and Rello
et al. (2012), this result could apply not only to paper materials but also to electronic materials.
Additionally, based on the findings of McTigue and Slough (2010), it can be applied to improve theunderstanding of general texts. A limitation of this study is that the results of this investigation on
the topic of developmental disabilities in students are limited in terms of text teaching materials
on employment training. However, information presentation can be applied regardless of the text
content. Therefore, further verification is necessary. To clearly show whether the information
presentation method extracted from this research is generalizable to other teaching materials andan understanding of the general contents of the study, it is necessary to conduct further research.
However, one issue that should be openly addressed as a prospect for future study is interactive
reading materials and other technological enhancements, which are an increasing research focus.
In this study, responses were not obtained by recalling individual cases, but through a procedurein which the respondents were presented with definitions of LD, ADHD, and ASD and asked torespond to the considerations for each disability characteristic based on their own experience insupporting persons with developmental disabilities in the workplace. Respondents responded
only to those disability types to which they were able to respond based on their experience inproviding support. Therefore, some respondents might have responded regarding all disability types,
others only regarding some. However, respondents were not asked for details on which of the LD,
ADHD, and ASD disability characteristics they had experience supporting, so they might not haveexperience supporting all disabilities. This point is considered a limitation of this study that should
be addressed in future research.

5. Conclusion
This study clarified support providers’ consideration of information presentation methodsof teaching materials that consider the characteristics of students (persons) with developmental
disabilities. The results of this study may contribute to the optimization of teaching materials forstudents with developmental disabilities to promote understanding and learning.
Acknowledgment
This work was supported by JSPS KAKENHI Grant Numbers JP20830144, JP20H01702.
Note
1. This study was conducted more than 10 years from the time of data acquisition to the timeof analysis.

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Journal of Developmental Disabilities Research No. 1

References
Broman, S. H. & Grafman, J. (Eds.). (2014). Atypical cognitive deficits in developmental disorders: Implications
for brain function. East Sussex, United Kingdom: Psychology Press.
Castles, A., Kohnen, S., Nickels, L. & Brock, J. (2014). Developmental disorders: What can be learned from
cognitive neuropsychology? Philosophical Transactions of the Royal Society of London. Series B, Biological
Sciences, 369(1634), 20130407. https://doi.org/10.1098/rstb.2013.0407
Enomoto (Terada), Y., Takezawa, T. & Inoue, T. (2016). Hattatsusyougai noaru Hito wo Taisyou toshita
Koutougakkoudankai deno Syuuroujyunbikyouiku ni Gyuuyou na Gakusyuunaiyou no Kentou [Significant
Learning Content in High Schools for Employment Preparatory Education of Persons with Developmental
Disabilities]. Japanese journal of learning disabilities, 25 (1), 105-120.
Finnegan, E. & Mazin, A. L. (2016). Strategies for increasing reading comprehension skills in students with
autism spectrum disorder: A review of the literature. Education and Treatment of Children, 187-219.
Fujita, K., Maekawa, H., Dairoku, H. & Yamanaka, K. (2006). WAIS-III Seijinchinoukensa [Japanese version
Wechsler Adult Intelligence Scale ─ Third Edition]. Tokyo: Nihon Bunka Kagakush.
Hoover, K. (2011). Text preferences of a student with attention deficit hyperactivity disorder: A case study[Doctoral Dissertation]. Bowling Green State University.
Japan Parents’ Association of Learning Disabilities (2008). LD nadono Hattatsusyougai noaru Koukousei
no Jittaicyousahoukoku [Report on the Actual Conditions of High School Students with LD and Other
Developmental Disabilities]. Tokyo, Japan: Japan Parents’ Association of Learning Disabilities.
Kanai, C., Hashimoto, R., Itahashi, T., Tani, M., Yamada, T., Ota, H. & Kato, N. (2017). Cognitive profiles ofadults with high-functioning autism spectrum disorder and those with attention-deficit/hyperactivity
disorder based on the WAIS- III. Research in Developmental Disabilities, 61, 108–115. https://doi.
org/10.1016/j.ridd.2016.12.008
Kanai, C., Tani, M., Hashimoto, R., Yamada, T., Ota, H., Watanabe, H. & Kato, N. (2012). Cognitive profilesof adults with Asperger’s disorder, high-functioning autism, and pervasive developmental disorder nototherwise specified based on the WAIS-III. Research in Autism Spectrum Disorders, 6(1), 58–64. https://doi.org/10.1016/j.rasd.2011.09.004
Larkin, J. H. & Simon, H. A. (1987). Why a diagram is (sometimes) worth ten thousand words. Cognitive
Science, 11(1), 65–100. https://doi.org/10.1111/j.1551-6708.1987.tb00863.x
Marino, M. T., Gotch, C. M., Israel, M., Vasquez III, E., Basham, J. D. & Becht, K. (2014). UDL in the
middle school science classroom: Can video games and alternative text heighten engagement andlearning for students with learning disabilities? Learning Disability Quarterly, 37(2), 87–99. https://doi.
org/10.1177/0731948713503963
Mayer, R. E., Steinhoff, K., Bower, G., & Mars, R. (1995). A generative theory of textbook design: Using
annotated illustrations to foster meaningful learning of science text. Educational Technology Research andDevelopment, 43(1), 31–41. https://doi.org/10.1007/BF02300480
McTigue, E. M. & Slough, S. W. (2010). Student-accessible science texts: Elements of design. Reading
Psychology, 31(3), 213–227. https://doi.org/10.1080/02702710903256312
Ministry of Education, Culture, Sports, Science, and Technology. (2011). Gakkou niokeru Hairyojikounado[Consideration at school. Special Needs Education Division]. http://www.mext.go.jp/b_menu/shingi/chukyo/
chukyo3/046/siryo/attach/1313585.htm. Accessed, 10, 26, 2021.
Ministry of Education, Culture, Sports, Science, and Technology (2019). Aatarashii Jidai no
Tokubetsushienkyouiku no Arikata nikansuru Yuushikisyakaigihoukoku [Report of the Expert Council on
Special Needs Education in the New Era]. https://www.mext.go.jp/b_menu/shingi/chousa/shotou/154/
─ 16 ─

Journal of Developmental Disabilities Research No. 1

mext_00644.html. Accessed, 5, 1, 2023.
Ministry of Health, Labour and Welfare, Social Welfare and War Victims’ Relief Bureau, & Department
of Health and Welfare for Persons with Disabilities. (2008). Hattatsusyougai no Rikai notameni [For theunderstanding of the developmental disabilities]. https://www.mhlw.go.jp/bunya/shougaihoken/hattatsu/
dl/01.pdf. Accessed, 10, 26, 2021.
National Institute of Vocational Rehabilitation (2015). Hattatsusyougaisya no Syokugyouseikatujyou no
Kadai to Sonotaiou nikansuru Kenkyu [Research on challenges in the professional lives of persons with
developmental disabilities and how to respond to them] ． National Institute of Vocational Rehabilitation
resource series，84.
National Institute of Vocational Rehabilitation (2009). Hattatsusyougaisya no Syuuroushien no Kadai nikansuru
Kenkyu [Research on issues of employment support for persons with developmental disabilities]． National
Institute of Vocational Rehabilitation research report, 88.
Rello, L., Kanvinde, G. & Baeza-Yates, R. (2012). Layout guidelines for web text and a web service toimprove accessibility for dyslexics. Proceedings of the International Cross-Disciplinary Conference on Web
Accessibility. https://doi.org/10.1145/2207016.2207048. France: Lyon.
Scupin, R. (1997). The KJ method: A technique for analyzing data derived from Japanese ethnology. Human
Organization, 56(2), 233–237. DOI: 10.17730/humo.56.2.x335923511444655
Seki, Y. (1997). Tekisuto no Naiyohaaku nitaisuru Kajyogaki to Kīwādokyouchou no Eikyo [Effects ofitemization and highlighting key words on text comprehension], Japan Society for Educational Technology,
21, 17–20.
Shimada, H. (2016). Kyozai no Kouseiyouso ga Dokkai heno Doukizuke niataeru Eikyo [Effects of components
of educational materials on motivation for reading]. Japanese Journal of Educational Psychology, 64, 296–306.
Shimada, H. & Kitajima, M. (2008). Sashie ga Manual no Rikai wo Sokushin suru Ninchiprosesu [Why doillustrations promote comprehension of manuals? Effects of motivation and elaboration]. Japanese Journal of
Educational Psychology, 56, 474–486.
Singh, B. D., Moore, D. W., Furlonger, B. E., Anderson, A., Fall, R. & Howorth, S. (2021). Reading
comprehension and autism spectrum disorder: A systematic review of interventions involving singlecase experimental designs. Review Journal of Autism and Developmental Disorders, 8(1), 3–21. https://doi.
org/10.1007/S40489-020-00200-3
Stringfield, S. G., Luscre, D. & Gast, D. L. (2011). Effects of a story map on accelerated reader postreading testscores in students with high-functioning autism. Focus on Autism and Other Developmental Disabilities,
26(4), 218–229. https://doi.org/10.1177/1088357611423543
Terada, Y. (2006). Tokubetsushienkyouiku no Jyouhougen toshiteno Handobukku ni Kyouin no Jyuyou wo
Hanei saserutameno Chiekkurisuto no Sakusei [Making of checklists to reflect teacher’s demand in thehandbook as the source of the Special Support Education]. Bulletin of the Graduate School of Education,
Hiroshima University, 55, 91-98.
Waight, M, & Oldreive, W. (2020). Investigating accessible information formats with people who have learning
disabilities. Learning Disability Practice, 23(2), 23–30. https://doi.org/10.7748/ldp.2020.e2031’
Wechsler, D. (1997). WAIS ‐ III administration and scoring manual. San Antonio, TX, United States:
Psychological Corporation.

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［Original Article］

Relationship between Burnout, Mental Health, and Assertivenessamong Nursery school teachers of Children with Special Needs
Mami Shiratori

Graduate School of Comprehensive Human Sciences, University of Tsukuba/
Department of Child Education, Teikyo Junior College

Michio Kojima

Faculty of Human Sciences, University of Tsukuba

Motoko Igarashi

Department of Child Studies, Shiraume Gakuen University

Abstract
Background: It has been suggested that caring for children with special needs in the generalclassroom is a dangerous stressor that can lead to poor mental health among nursery school teachers.
Another problem in Japan is the existence of nursery school teachers who hold certifications but do
not work as nursery school teachers, or who leave their jobs because of workplace relationships.
Objective: To investigate the mental health of nursery school teachers when caring for children
with special needs, we will identify the relationship between stressors, mental health, and burnout
measures. Additionally, to examine the relationship between assertiveness and the mental health ofnursery school teachers because it is expected to reduce relationship stress.
Method: A questionnaire was administered to nursery school teachers. Covariance structure
analysis was used to determine the stressors scale in Inclusive Education (SSIE), burnout (J-MBI),
mental health (J-WHO-5), and self-assertion (J-RAS) in an inclusive childcare environment forJapanese nursery school teachers.
Results: Approximately 60% of nursery school teachers were found to be in the mental healthdisorder group. Furthermore, it was verified that an increase in J-RAS not only decreases SSIE but
also increases J-WHO-5 and may decrease burnout tendency. Nursery school teachers who currently
care for children with medical care needs argued that they are more likely to experience stressors.
Conclusion: Nursery school teachers who care for children who need medical care are expected
to experience worsening mental health, and immediate support is needed. Since nursery school
teachers with high levels of assertiveness also have high values of mental health, we hope that
assertiveness training for nursery school teachers will be developed.
Keywords: Japanese nursery school teachers, children with special needs, stressors and psychologicalresponse

1.

Introduction

In Japan, preschool facilities are divided into three categories: kindergartens for educational
purposes for children aged 3 to pre-elementary school, under the jurisdiction of the Ministry of
Education, Culture, Sports, Science and Technology (MEXT); nursery schools and child welfare─ 18 ─

Journal of Developmental Disabilities Research No. 1

facilities for children aged 0 to pre-elementary school, under the jurisdiction of the Ministry of
Health, Labor and Welfare (MHLW); and certified childcare facilities that combine the functions ofboth kindergarten and nursery school, under the jurisdiction of the Cabinet Office (CAO). According
to the survey conducted from 2021 to 2022, the number of children in nursery schools isapproximately 2.6 million (MHLW, 2022), whereas the number of children in kindergartens is nearly
0.92 million (MEXT, 2022). Meanwhile, the number of children in certified childcare facilities is 1.06
million (Cabinet Office, 2021). According to Ikeda and Okawa (2012), kindergarten teachers andchildcare workers are similar in several aspects, but they have different stressors and stress-related
factors. Thus, the present study examines a sample of nursery school teachers in day-care centers,
representing the largest group of subjects among those working in preschool facilities in Japan.
In recent years, the demand for childcare facilities has been rapidly increasing due to theincrease in number of dual-earner families, and the “Plan for Securing Nursery School Teachers”(launched by the Ministry of Health, Labor and Welfare in 2015) made the securing of nursery school
teachers an important issue in Japan. However, there is still an acute shortage of nursery school
teachers, and the deteriorating mental health of such teachers has been indicated as the main reason
for this shortage. A survey using the Japanese version of the Kessler Screening Scale for
Psychological Distress (K6) has been conducted to clarify the mental health of nursery school
teachers. The results indicated that 60.0% of nursery school teachers showed a prevalence of
psychological distress (K6 score ≥ 5) (Yaginuma-Sakurai et al., 2020). In addition, according to
Akagawa and Kimura (2019), up to 20% of nursery school teachers are already in a state of burnout(Akagawa and Kimura, 2019).Given this situation, investigating the mental health of nursery school
teachers would be helpful in preventing early job turnover. The high prevalence of burnout has also
been noted in many countries (Aboagye et al., 2018; Tasic et al., 2020). The poor mental health ofnursery school teachers can be considered an issue in many countries around the world.
Further, the number of children with special needs is increasing in Japan. According to a survey
conducted in 2018, the percentage of the number of nursery schools that reported having children
with special needs was as high as 83.2% (MHLW, 2017). With the Salamanca Declaration, the idea andpractice of inclusive education have become a global principle and are becoming more widespread in
the country. The United Nations Educational, Scientific and Cultural Organization (UNESCO) defines“special educational needs” to include not only children with disabilities but also gifted children,
street children, working children, children from remote areas, nomadic children, and other children
living in disadvantaged or remote areas. Children living in remote areas, nomadic children, and otherdisadvantaged or marginalized children are all in need of support (UNESCO, 1994). In response tothis trend, the core curriculum for teaching in Japan, which clarifies the qualities and abilities thatshould be commonly acquired in teaching programs, has been revised since 2017 to include children
with special needs, such as those who have problems with their mother tongue and poverty andhave learning and living difficulties and those who need systematic support. In the curriculum,children with special needs include those who have problems with their native language and poverty,
learning or living difficulties, or organizational needs (MEXT, 2017).
It has been suggested that caring for children with special needs is a dangerous stressor thatcan lead to poor mental health in nursery school teachers. Faulkner et al. (2016) explored the workstress of childcare providers through semi-structured interviews. Among the stresses of childcare
providers, dedication to the impact of factors, such as poverty and domestic violence on children, wascited. It was also elucidated that identifying problems faced by children and providing support toparents, especially single parents, also contribute to the stress of childcare workers (Faulkner et al.,─ 19 ─

Journal of Developmental Disabilities Research No. 1

2016). However, defining children with special needs is very difficult (Japan Council for Childcare
Issues, 2021). Hence, previous studies have limited the scope of children with special needs tochildren with disabilities (Štemberger and Kiswarday, 2018) or categorized them by the presence orabsence of a disability label (Kiso, 2016). Most of the scales employed in previous studies to identify
concerns about inclusive education have also been developed with the assumption that children withdisabilities would be integrated into general classes (Jobe et al., 1996; Sharma and Desai, 2002).
Against this background, stress among nursery school teachers must be investigated considering thediverse and changing perceptions of children with special needs.
It has also been reported that the stress of nursery school teachers is largely influenced by theirperceptions and personal characteristics. Finding a relationship between cognitive appraisals andstress in nursery school teachers, Friedman-Krauss et al. (2014) reported that teachers who
perceived higher levels of children’s behavioral problems also felt higher levels of stress from theirwork and that this relationship was statistically significant (Friedman-Krauss et al., 2014). An
American study on early childhood teachers who teach children from infants to third grade has
noted that the impact of inclusive education on their concerns is mediated by their confidence inteaching children with disabilities (Park et al., 2018). In addition, the study has also examined thepersonal characteristics of caregivers, such as self-efficacy, past childcare experience, whether they
have had contact with children with disabilities, gender, age, grade level taught, academic status, andtraining.
Therefore, the present study focused on assertiveness, which has never been investigated as apersonal factor affecting stress. Assertiveness is a method of self-expression that started in the 1970sin the U.S. It refers to communicating appropriately while respecting the other person, rather thanstating one’s point of view one way or the other. The concept of assertiveness was popularized inJapan by Hiraki (1993). A related study on nurses reported that developing assertive communication
allows them to communicate their feelings in an honest and appropriate manner, leading to stress
reduction and improved mental health (Daigo et al., 2010). Furthermore, According to Jovanović et al.
(2019), teachers who are in charge of children with developmental disabilities have less work-relatedburnout than teachers with higher levels of assertiveness (Jovanović et al., 2019). According to asurvey by the Tokyo Metropolitan Government’s Bureau of Social Welfare and Public Health (2018),
workplace relationship is the principal reason why nursery school teachers leave their jobs. Sincesuch teachers are expected to communicate with several people, including parents and colleagues,
they must have the ability to manage stress related to workplace relationships. Thus, learning
assertive communication is expected to help nursery school teachers effectively build healthy
workplace relationships and reduce overall stress.
In the current research, the relationship between stressors, mental health, and burnout scales
will be clarified to investigate the mental health of nursery school teachers when caring for children
with special needs. Yoshikane and Hayashi (2010) explored the relationship between the presence or
the absence of a child with developmental characteristics in the classroom and the burnout index. In
this study, nursery school teachers were more likely to experience burnout than kindergarten
teachers, highlighting that nursery school teachers spend more time with children as a factor(Yoshikane and Hayashi, 2010). Additionally, according to Kiso (2013), as the number of undiagnosed
developmentally disabled children increases, nursery school teachers are more likely to suffer fromburnout(Kiso, 2013). A study in Turkey also affirmed that having integration students enrolled or notin the current class did not affect the burnout index of preschool teachers (Sahbaz and Kocer, 2017).
Comparing these studies is difficult simply because they were conducted in different countries, and─ 20 ─

Journal of Developmental Disabilities Research No. 1

the instruments utilized were distinct from each other. In addition, there have been no studies
conducted on nursery school teachers or on whether children with special needs are enrolled in the
program, which made us feel the need to investigate this issue.
Furthermore, this study will clarify the relationship between assertiveness and mental healthburnout among nursery school teachers. Given that nursery school teachers interact with many
people, including children, colleagues, and parents, they must learn how to communicate assertively.

2.

Research Methods

In this study, we conducted a questionnaire survey of nursery school teachers. The survey
examines whether the stressors of caring for children with special needs affect mental health andburnout and their relationship with assertiveness as a personal factor. An online survey was chosen
as the method of data collection because it is more efficient to survey nursery school teachers in awide range of communities.
2.1

Procedure
The survey was commissioned to an Internet research company (Rakuten Insight) that has
roughly 2.2 million registered monitors. According to the 2018 survey, of the 1.54 million registerednursery school teachers, 590,000 are working as nursery school teachers (MHLW, 2020a). The numberof registered nursery school teachers is 590,000 out of 1.54 million. We conducted a screening andselected 300 nursery school teachers who are certified as nursery school teachers and are currently
working as classroom teachers in childcare centers to complete this survey. Care was taken to makethe bias due to region and age as even as possible to prevent bias due to regional differences andage. The survey was sent out on March 12, 2021 and the collection of 300 respondents was completed
on March 15, 2021. The valid response rate was 100% as the system was designed so that responses
could not be completed in case of incompleteness.
As an ethical consideration, this study was conducted after obtaining approval from the ****
Ethical Review Committee (approved November 1, 2020; No. 21). The survey system was initiatedonly after the research subjects reviewed and agreed to the privacy policy of the Internet ResearchCompany Survey (https://member.insight.rakuten.co.jp/explanation/privacy/). It is clearly stated in
the terms of use that the information obtained from the survey and the individual will only bepresented in a form that cannot be identified and will not be used for any purpose other than that of
the survey.
2.2

Participant
The subjects were 300 nursery school teachers who were qualified and currently working asclassroom teachers. As for gender, 14(4.70%) were males, 286(95.3%) were females, 65(21.7%) were in
their 20s, 129(43.0%) were in their 30s, 66(22.0%) were in their 40s, and 29(13.3%) were in their 50s orolder. As for the type of employment, 222(74.0%) were in standard employment, 18(6.0%) in nonstandard employment, and 59(20.0%) in part-time employment, and 1(0.3%) were others. The lasteducational background of 43(14.4%)  students was vocational school, 180(60.0%) were junior college,
75(25.0%) were university, and 2(0.70%) were other. As for the classes they oversaw, 186(62.0%) werein the infant class, 100(33.3%) were in the toddler class, 11(3.7%) were in free charge, and 3(1.0%) werein other classes. With regard to the establishment entities, 88(29.3%) were public, 167(55.7%) weresocial welfare corporations, 32(10.7%) were stock companies, and 13(4.3%) were others.
─ 21 ─

Journal of Developmental Disabilities Research No. 1

In Japan, the Core Curriculum for the Teaching Profession, which clarifies the qualities andabilities that should be commonly acquired in teaching programs, has clearly indicated theunderstanding and support for children who need special support, such as those who have problems
with their mother tongue or poverty, learning or living difficulties, or need systematic support(MEXT, 2017). In the present research, children with special needs were classified into the following
seven categories: (1) children diagnosed as having disabilities, (2) children without a diagnosis buthaving special developmental needs, (3) children experiencing poverty, (4) children having needs forsupport due to their family environment, (5) children having been abused, (6) children requiring
language support due to foreign nationality, and (7) children calling for medical care. For each item,
the respondents were asked to answer in three ways: “currently in caring,” “have experience incaring,” or “have no experience in caring” (Table 1). Regarding whether they have looked afterchildren diagnosed as having disabilities, 62(20.7%) were currently in caring, and 162(54.0%) had
experience in caring. In terms of whether they have overseen children without a diagnosis buthaving special developmental needs, 129(43.0%) are currently in caring of such children, and133(44.3%) have overseen such children. In regard to whether they have had experience in caring forchildren who require medical care, 19(6.3%) are currently in charge, and 198(66.0%) had no experiencein taking charge, with the largest number of the respondents having no experience in taking caring.
2.3 Measurement method
2.3.1 The Stressor Scale in Inclusive Education
We employed the Scale in Inclusive Education (SSIE), which was developed by the authors. The
scale comprises five questions ranging from “I do not feel stress at all” to “I feel very stressed” whenassuming stressful situations in inclusive education. The questionnaire consists of 21 items, including“difficulty in dealing with children” (eight items), “human relations with parents and other children in
the class” (seven items), “insufficient self-expertise” (two items), “burden of keeping childcare records”(two items), and “insufficient support from colleagues” (two items). This scale has Cronbach’s
reliability coefficients of α = .84 to .93, which ensures internal consistency, based on a survey of 211
nursery school teachers. On the basis of the results of confirmatory factor analysis, the goodness ofTable 1

Experience in caring for children with special needs

Experience in caring for children with special needs

Currently inchargeHaveexperiencein caringNoexperiencein caring

N

%

N

%

N

%

(1)

Children diagnosed as having disabilities

62

20. 7

162

54. 0

76

25. 3

(2)

Children without a diagnosis but having special
developmental needs

129

43. 0

133

44. 3

38

12. 7

(3)

Children experiencing poverty

32

10. 7

99

33. 0

169

56. 3

(4)

Children with needs for support due to their family
environment

72

24. 0

149

49. 7

79

26. 3

(5)

Children having been abused

31

10. 3

99

33. 0

170

56. 7

(6)

Children requiring language support due to foreign
nationality

40

13. 3

110

36. 7

150

50. 0

(7)

Children requiring medical care

19

6. 3

83

27. 7

198

66. 0

─ 22 ─

Journal of Developmental Disabilities Research No. 1

fit of the model is X²=384.144, df = 197, GFI = .869, AGFI = .832, CFI = .919, RMSEA = .067, and AIC= 469.144, and the validity can be verified (Shiratori & Kojima, 2022). Nonetheless, as this scale wasdesigned for nursery school teachers in five prefectures, mainly in the Kanto region, out of the 47
prefectures in Japan, it must be verified whether the factor structure can be replicated for nurseryschool teachers in a wider range of regions.
2.3.2 Burnout scale
The Maslach Burnout Inventory, which was translated into Japanese by Tao and Kubo wasutilized (Kubo and Tao, 1992; Maslach and Jackson, 1981). J-MBI has also been studied with nurseryschool teachers, and its reliability and validity have been verified (Akagawa and Kimura, 2019; Kiso,
2016). The questionnaire consists of 17 items, with three subscales, namely, “emotional exhaustion”(five items), which includes feeling mentally fatigued at work and wanting to quit work,“depersonalization” (six items), which includes avoiding contact with colleagues and children andfeeling less meaningful at work, and “decreased sense of personal accomplishment” (six items), which
includes feeling joyful, enthusiastic, and satisfied at work. The survey also comprises three subscales.
The responses were based on a five-point scale (1–5) ranging from “always” to “never.” The total
score for “personal accomplishment” was reversed to “decreased personal accomplishment,” with ahigher total score indicating higher burnout symptoms.
2.3.3 Mental health level
The “WHO-five Well-Being Index Japanese Version (J-WHO-5)” developed by the World HealthOrganization (WHO) was employed. The responses were based on a six-point scale (0–5) ranging
from “never” to “always.” A total score of 13 or more points indicates good mental health, and a scoreof 13 or less indicates poor mental health (Awata et al., 2007). A total score of 13 or higher indicatesgood mental health, while a score of 13 or lower indicates poor mental health to create a stress scale
for nursery school teachers and to examine its reliability and validity.
2.3.4 Assertiveness scale
J-RAS, translated by Suzuki et al. (2004) and completed after a review by several researchers,
including a translator from the U.S., was used (Rathus, 1973; Suzuki et al., 2004). Seventeen of the 30
items are reversed items, and the higher the total score after processing the reversed items, themore assertive the respondents. After processing the reversed items, the higher the total score, themore assertive the respondents. The minimum and maximum score ranges are from −90 to +90. In
the current study, the nursing students were surveyed, and the mean of the J-RAS total score was−12.0 (±20.2) (Suzuki et al., 2004).
2.4

Analysis method
For SSIE and J-MBI, the appropriateness of the factor structure was confirmed, andconfirmatory factor analysis was conducted with each item as the observed variable and themeasurement of each item as the latent variable.
For J-MBI, we conducted confirmatory factor analysis with each item as the observed variable
and each item as the latent variable. Multiple comparisons (Games–Howell method) were performed.
The results of these comparisons were shown only if differences were found.
An analysis of covariance structure was conducted with the factors of SSIE, J-WHO-5, J-MBI,and J-RAS as latent variables and the subscales of each scale as observed variables. Among thepaths between the assumed latent variables, those for which no significant path coefficients wereobtained were sequentially deleted one by one, starting with those with the smallest path coefficients(standard estimates). Thereafter, the deletion was repeated while checking the significance level of─ 23 ─

Journal of Developmental Disabilities Research No. 1

the other path coefficients, and the process was terminated when all the paths between latentvariables became significant. The appropriateness of the model was judged comprehensively fromthe three indices of goodness of fit index (GFI), comparative fit index (CFI), and root mean squareerror of approximation (RMSEA).
Statistical analysis was performed using SPSS 27.0 and AMOS 26.0.

3.

Results

3.1

Factor structure and total score of SSIE and J-MBI
Table 2 presents the mean values and standard deviations of SSIE and J-MBI. The Cronbachalpha coefficients were calculated to be high, ranging from α = .870 to .917 for SSIE and α = .789 to.879 for J-MBI. The GFI (.823–.859), CFI (.881–.896), and RMSEA (.088–.089). On the basis of acomprehensive review of the results, the factor structure of each scale was judged to be generally
appropriate.
3.2

 elationship between the personal attributes of nursery school teachers and SSIE, J-MBI, andR
J-WHO-5
A t-test, one-way analysis of variance, and multiple comparisons using the Tukey method wereconducted to clarify the relationship between the basic attributes of nursery school teachers and
SSIE, J-MBI, and J-WHO-5.
Table 3 exhibits the relationship between basic attributes and SSIE. Significant differences were
found in the age of nursery school teachers and “insufficient self-expertise” (p = .006–.027). There wasa significant difference between SSIE and the two subscales of “human relations with parents andother children in the class” and “burden of keeping childcare records” in terms of the relationshipwith the establishment of the childcare center (p = .002–.024).
I would like to examine the relationship between J-MBI. There was a significant difference
between the age of the nursery school teachers and “emotional exhaustion” and “depersonalization” (p= .004–.048). In “depersonalization,” there was a significant difference in the relationship between thetype of employment and the establishment entity (p = .006–.013) (Table 4).
For J-WHO-5, the maximum value was 25, the minimum value was 1, and the overall meanvalue was 12.8 (SD = 5.28). The mental health of the nursery school teachers was below the 13 points
that are in good mental health. This value is lower than the results of the study by Akada (2010),
Table 2
Scale
SSIE

J-MBI

Results of the confirmatory factor analysis of SSIE and J-MBI and the mean values of subscales
Fitness Index

SubscaleM

SD

GFI=. 823

Difficulty in dealing with children (8 items)

25. 85

6. 53

CFI=. 896

Human relations with parents and other children in
the class (7 items)

20. 78

5. 55

RMSEA=. 089

Insufficient self expertise (2 items)

6. 59

1. 80

Burden of keeping childcare records (2 items)

6. 72

2. 05

Insufficient support from colleagues (2 items)

5. 53

2. 05

GFI=. 859

Emotional exhaustion (5 itemes)

13. 48

4. 54

CFI=. 881

Depersonalization (6 itemes)

21. 35

5. 76

RMSEA=. 088

Decreased sense of personal accomplishment (6 itemes)

17. 35

4. 51

─ 24 ─

─ 25 ─

4

3

2

2
3
4
1
2
3
4
1

1

3
4

2

1

1
2
1
2
3
4

Male
Female20s
30s
40s
50s and older
Full-time
employment
Part-time
employment
Part-time job
Other
Vocational
schoolJunior college
University
Other
Infant class
Toddler classFree charge
Other
PublicSocial welfare
service
corporation
Joint-stockcompanies
Other

25. 8
23. 5025. 96
27. 37
25. 46
25. 64
24. 98

6. 28

6. 15
-

5. 36

6. 69

6. 53
4. 54
6. 59
6. 14
6. 84
6. 19
6. 49

13(4. 3) 23. 8532(10. 7) 26. 78
6. 16

5. 88

6. 44
n. s.

n. s.

n. s.

n. s.

n. s.

n. s.

Factor ⅠSDp

25. 93 6. 54
25. 87 6. 64
26. 00 12. 73
25. 93 6. 52
25. 92 6. 30
25. 09 8. 85
21. 00 6. 24
26. 19 6. 97

167(55. 7) 25. 64

180(60. 0)75(25. 0)2(0. 7)
186(62. 0)100(33. 3)11(3. 7)3(1. 0)88(29. 3)

43(14. 3) 25. 47

59(20. 0) 24. 530(0. 0)-18(6. 0) 25. 56

222(74. 0) 26. 19300(100)
14(4. 7)286(95. 3)65(21. 7)
129(43. 0)66(22. 0)40(13. 3)

M

16. 15

19. 5920. 78

20. 83
21. 15
15. 0020. 47
21. 51
20. 18
18. 33
21. 91

20. 21

19. 44-

19. 3921. 22

20. 78
21. 21
20. 76
21. 57
20. 57
21. 27
19. 40

M

5. 06

5. 78

5. 81

5. 64
5. 71
1. 41
5. 60
5. 42
5. 81
4. 93
4. 57

4. 87

4. 76
-

4. 13

5. 77

5. 55
2. 89
5. 65
5. 03
5. 61
5. 32
6. 36

1-4**
2-4*

n. s.

n. s.

n. s.

n. s.

1-2*

Factor Ⅱ
SD
p

6. 15

6. 53

6. 48

6. 52
7. 07
5. 00
6. 46
6. 87
6. 18
6. 33
6. 88

6. 12

6. 20
-

6. 56

6. 69

6. 59
6. 64
6. 58
7. 17
6. 41
6. 71
6. 00

M

1. 86

1. 76

1. 77

1. 73
1. 93
1. 41
1. 83
1. 80
1. 40
0. 58
1. 86

1. 73

1. 60
-

1. 50

1. 87

1. 80
1. 95
1. 80
1. 91
1. 82
1. 51
1. 81

n. s.

n. s.

3-1*

n. s.

1-2*
1-4**

n. s.

Factor Ⅲ
SD
p

5. 38

6. 91

6. 59

6. 69
6. 92
5. 00
6. 49
7. 30
5. 82
4. 67
7. 10

6. 58

6. 10
-

5. 94

6. 95

6. 72
7. 50
6. 68
6. 98
6. 92
6. 47
6. 05

M

1. 89

2. 19

2. 02

1. 99
2. 15
1. 41
2. 09
1. 87
2. 04
1. 15
2. 01

2. 17

1. 84
-

2. 46

2. 03

2. 05
2. 35
2. 03
1. 90
2. 17
2. 00
1. 84

1-4*

1-2**

n. s.

1-2*

n. s.

n. s.

Factor ⅣSDp

Relationship between the basic attributes of nursery school teachers and J-MBI

4. 54

5. 88

5. 67

5. 52
5. 64
4. 00
5. 54
5. 59
5. 27
4. 33
5. 30

5. 49

5. 17
-

5. 11

5. 66

5. 53
5. 36
5. 54
5. 77
5. 57
5. 26
5. 50

M

2. 11

2. 24

2. 11

1. 96
2. 12
2. 83
2. 14
1. 85
2. 37
2. 08
1. 80

2. 28

1. 65
-

1. 81

2. 15

2
2. 21
2. 04
2. 01
2. 05
2. 06
2. 11

n. s.

n. s.

n. s.

n. s.

n. s.

n. s.

Factor ⅤSDp

Note:Factor Ⅰ Difficulty in dealing with children，Factor Ⅱ Human relations with parents and other children in the class，Factor Ⅲ Insufficient self
expertise，Factor Ⅳ Burden of keeping childcare records，Factor Ⅴ Insufficient support from colleagues. Gender was subjected to t-test. Other items
were subjected to one-way analysis of variance followed by the Tukey method as a subsequent test. * p<. 05，**p<. 01.

EstablishedClass inchargeFinal
educational
background

Employment
statusAge

GenderOverallN(%)

Table 3

Journal of Developmental Disabilities Research No. 1

Journal of Developmental Disabilities Research No. 1

Table 4

Basic attributes of nursery school teachers and their relationship to SSIE
Factor Ⅰ
M

Overall
Gender

Age

Employment
statusFinaleducational
background

Class inchargeSD

Factor Ⅱp

M

SDFactor Ⅲp

M

SD

13. 50

4. 54

21. 35

5. 76

17. 35

4. 51

1

Male

13. 00

3. 04

20. 50

4. 07

18. 36

3. 32

2Female13. 51

4. 60

21. 395. 83

17. 30

4. 56

1

20s

12. 32

4. 20

19. 85

5. 12

17. 06

4. 11

2

30s

12. 95

4. 65

21. 14

5. 95

17. 19

4. 71

3

40s

14. 52

4. 14

22. 35

5. 89

17. 704. 59

450s and older

15. 38

4. 56

22. 83

5. 42

17. 80

4. 44

1Full-time
employment

12. 96

4. 53

20. 75

5. 88

17. 21

4. 63

2Part-time
employment

14. 33

4. 77

22. 94

6. 01

18. 56

3. 93

3Part-time job

15. 31

4. 00

23. 25

4. 69

17. 59

4. 22

-

-

-

-

-

-

14. 445. 06

23. 07

5. 61

17. 19

4. 57

4

Other

1

Vocational
school2Junior college

13. 36

4. 49

3University

13. 13

4. 15

n. s.
3-1*
4-2*
4-1**

3-1**

n. s.

21. 41

5. 82

20. 27

5. 40

n. s.

3-1*
4-1*

3-1*

n. s.

17. 094. 35

18. 13

4. 77

4

Other

17. 5010. 61

20. 0012. 73

15. 00

8. 49

1Infant class

13. 394. 72

21. 40

5. 99

17. 43

4. 82

2Toddler class

13. 44

4. 20

3Free charge

15. 09

4. 83

4

Other

15. 001

Public2Social welfare
service
corporation

3

Joint-stockcompanies

13. 28

3. 70

22. 25

5. 96

16. 66

4. 79

4

Other

15. 92

5. 14

26. 31

3. 43

18. 38

4. 11

Established

21. 18

5. 37

22. 18

5. 62

3. 00

20. 67

13. 33

4. 72

13. 41

4. 53

n. s.

16. 90

3. 86

18. 91

3. 67

7. 02

22. 00

5. 29

21. 17

5. 59

16. 82

4. 69

20. 89

5. 79

17. 69

4. 38

n. s.

n. s.

4-1*
4-2**

p

n. s.

n. s.

n. s.

n. s.

n. s.

n. s.

Note:Factor Ⅰ emotional exhaustion, Factor Ⅱ depersonalization, Factor Ⅲ Decreased sense of personal
accomplishment. Gender was subjected to t-test. Other items were subjected to one-way analysis ofvariance followed by the Tukey method as a subsequent test. * p<. 05，**p<. 01.

which revealed that the mental health status of nursery school teachers is deteriorating. The best
mental health status was found in the free charge category, with a score of 17.64. By contrast, theworst mental health status was 11.71 for male nursery school teachers. Although there was asignificant difference in mental health status depending on the class they were in charge of (p =.009–.023), there was no significant difference between the other basic attributes and J-WHO-5.
Finally, the relationship between J-RAS and the basic attributes: the maximum total score of
J-RAS was 42, and the minimum was −63, with an overall mean of −3.49 (SD = 16.41). Comparedwith a study conducted on nurses in Japan, −6.6 (SD = 19.7) for managerial nurses and −12.4 (SD =─ 26 ─

─ 27 ─12. 56
13. 21
11. 84
12. 08Junior college

University

Other

Infant class

Toddler classFree charge

Other

PublicSocial welfare service
corporation

Joint-stock companies

Other

4

1

2

3

4

1

2

3

12. 67

17. 64

12. 8912. 51

11. 0012. 65

13. 01

12. 44-

14. 32

13. 003Part-time job

32Part-time employment2

12. 41

13. 50

Other

Full-time employment

1

Vocational school

50s and older

4

13. 02

440s

3

12. 74

12. 38

12. 88

11. 71

1

20s

30s

1

Female

2

2

Male

1

M
12. 82

SD

6. 40

4. 95

5. 22

5. 35

3. 51

3. 91

5. 15

5. 33

11. 31

4. 93

5. 28

5. 75

-

5. 63

4. 89

5. 16

5. 60

5. 30

5. 51

4. 60

5. 32

4. 25

5. 28

n. s.

3-1**
3-2*

n. s.

3-1*

n. s.

n. s.

p

M

56. 15

48. 9448. 9048. 1952. 33

51. 55

48. 5249. 0850. 0048. 3948. 68

51. 47-

52. 33

51. 94

47. 88

52. 43

50. 8648. 2846. 4949. 03

48. 5749. 01

8. 40

9. 48

9. 22

10. 25

13. 01

8. 66

8. 69

10. 11

25. 46

8. 95

9. 77

9. 30

-

7. 72

10. 26

9. 80

9. 19

8. 87

10. 54

7. 71

9. 74

6. 80

9. 61

SD

J-MBI

n. s.

n. s.

n. s.

3-1**

3-1*
4-1*

n. s.

p

M

-3. 77-5. 09-2. 71-4. 36

13. 50-5. 79-2. 57-4. 14

13. 50-5. 79-2. 57-4. 14--0. 09-3. 71-3. 58

1. 53-3. 18-3. 01-7. 86-3. 690. 50-3. 4915. 6015. 25

15. 5018. 66

13. 44

16. 05

15. 3920. 56

13. 44

16. 05

15. 3920. 56-

17. 14

16. 13

16. 71

17. 01

12. 18

17. 36

17. 13

16. 25

19. 65

16. 41

SD

J-RAS

n. s.

n. s.

n. s.

n. s.

n. s.

n. s.

p

Gender was subjected to t-test. Other items were subjected to one-way analysis of variance followed by the Tukey method as asubsequent test. *p<. 05，**p<. 01.

EstablishedClass inchargeFinal
educational
background

Employment
statusAge

GenderOverall

J-WHO-5

Table 5 Relationship between the basic attributes of nursery school teachers and J-WHO-5 and J-RAS

Journal of Developmental Disabilities Research No. 1

Journal of Developmental Disabilities Research No. 1

20.8) for new nurses (Suzuki et al., 2017), the assertiveness level of nursery school teachers was foundto be higher than that of nurses (Table 5).
Finally, all the groups with very low J-RAS scores were in the J-WHO-5 low group. There wasalso a significant difference in J-WHO-5 high and low groups with low or slightly low J-RAS scores(p < .001) (Figure 1).
3.3

Relationship between experience in caring for children with special needs and SSIE, J-MBI,and J-WHO-5
A one-way analysis of variance was conducted to determine if there was a difference between
SSIE and SSIE according to experience in caring for children with special needs. After the analysis
of variance, the Tukey method was used for the multiple comparisons of equal variances, the Games–
Howell method was employed for unequal variances, and significant differences were found only
between those with and without experiences in caring for children with medical care needs andSSIE. For the SSIE subscale “human relations with parents and other children in the class,” there
was a significant difference (p = .010) between the SSIE subscale “human relations with parents andother children in the class” and SSIE. For the SSIE subscale “insufficient self-expertise,” there was asignificant difference between “have experience in caring childcare teachers” compared with “noexperience as a caring childcare teacher” (p = .031) (Table 6).
Subsequently, a one-way analysis of variance was conducted to determine if there was adifference between J-BMI and experience in caring for children with special needs. As there wereTable 6

Relationship between SCIE and the childcare experiences of children requiring medical care
SSIE

Factor Ⅰ

Factor Ⅱ
Childrenrequiring
medicalcare

Factor Ⅲ

Factor Ⅳ

Factor Ⅴ

Multiplecomparison

M

SD

df

F

p

2. 0

0. 25

0. 818

n. s.

2. 0

3. 01

0. 011

1-2**
1-3*

2. 0

3. 61

0. 034

2-3*

2. 0

1. 89

0. 070

n. s.

2. 0

0. 12

0. 829n. s.

1Currently in caring

3. 3

0. 9

2

Have experience in caring

3. 1

0. 8

3

No experience in caring

3. 2

0. 8

1

Currently in caring

3. 3

0. 5

2

Have experience in caring

2. 9

0. 9

3

No experience in caring

3. 0

0. 7

1

Currently in caring

3. 5

1. 0

2

Have experience in caring

3. 1

0. 9

3

No experience in caring

3. 4

0. 9

1

Currently in caring

3. 7

0. 7

2

Have experience in caring

3. 2

1. 0

3

No experience in caring

3. 4

1. 1

1

Currently in caring

2. 9

0. 8

2

Have experience in caring

2. 7

1. 0

3

No experience in caring

2. 8

1. 1

Note:Factor Ⅰ Difficulty in dealing with children，Factor Ⅱ Human relations with parents and otherchildren in the class，Factor Ⅲ Insufficient self expertise，Factor Ⅳ Burden of keeping childcare records，
Factor Ⅴ Insufficient support from colleagues.
After one-way analysis of variance, multiple comparison (Games-Howell) was used. *p<. 05，**p<. 01.
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Journal of Developmental Disabilities Research No. 1

Table 7

Relationship between J-MBI and children requiring language support due to foreign nationality
J-BMI
FactorChildrenrequiringlanguagesupportdue toforeignnationality

Ⅰ

Ⅱ

Ⅲ

M

SD

1

Currently in caring

13. 3

4. 9

2

Have experience in caring

13. 8

4. 7

3

No experience in caring

13. 3

4. 4

1

Currently in caring

13. 8

4. 7

2

Have experience in caring

21. 2

5. 8

3

No experience in caring

17. 6

4. 7

1

Currently in caring

13. 5

4. 5

2

Have experience in caring

21. 4

5. 8

3

No experience in caring

17. 4

4. 5

Multiplecomparison

df

F

P

2. 0

0. 31

0. 734

n. s.

2. 0

0. 05

0. 949

n. s.

2. 0

3. 78

0. 0241-3*

Note:Factor Ⅰ Emotional exhaustion ，Factor Ⅱ Depersonalization ，Factor Ⅲ Decreased sense of personal
accomplishment. After one-way analysis of variance, multiple comparison (Tukey) was used. *p<. 05，**p<. 01.

p

Figure 1

Distribution of J-RAS score in J-WHO-5 high and low groups

equal variances, the analysis of variance was followed by multiple comparisons (Tukey), and theresults confirmed that nursery school teachers who had experience with “children requiring
language support due to foreign nationality” were more likely to have “decreased sense of personal
accomplishment” than their current counterparts (p = .026) (Table 7).
Finally, a t-test was conducted to determine if there was a difference between the 181(60.3%)
children with good mental health status and the 119(39.7%) ones with poor mental health status in
J-WHO-5 and experience in caring for children with special needs. Consequently, no significant
differences were found in any of the items.
3.4

Examination of the model by covariance structure analysis
The SSIE, J-MBI, J-WHO-5, and J-RAS factors were used as latent variables, and the subscalesof each factor were employed as observables. For J-RAS, the total score was calculated and utilized─ 29 ─

Journal of Developmental Disabilities Research No. 1

Figure 2

Model diagram of SSIE, J-MBI, J-WHO-5, and J-RAS

as an observational variable. According to previous studies, a model with a GFI of .94 or higher, an
AGFI of .90 or higher, and an RMSEA of less than .01 is considered to have a good fit (Takagi andTanaka, 2003). During the creation of the model, the corrections were made repeatedly byintroducing error correlations based on correction indices. Consequently, the goodness of fit indicesof the model that specified the interrelationships among the four scales showed acceptable fit values(X² = 184.973, df = 72, GFI = .919, AGFI = .882, CFI = .937, RMSEA = .072, and AIC = 250.973).
Figure 2 illustrates that the path coefficients of the model demonstrated a direct effect from SSIE to
J-MBI, but no path from SSIE to J-WHO-5. The J-RAS total score was significant for the SSIE
subscale, insufficient self-expertise, and the direct effect to J-WHO-5.

4.

Discussion

4.1

Relationship between the childcare experience of children with special needs and the SSIE,
J-MBI, and J-WHO-5 of nursery school teachers
Children with special needs were categorized into seven items, and the relationship between
their childcare experience and stress-related factors was clarified. The results validated that there
was no significant difference between SSIE, J-MBI, and J-WHO-5 for the items other than (6)children requiring language support due to foreign nationality and (7) children requiring medicalcare. There was no significant difference between SSIE, J-MBI, and J-WHO-5. This result waspartially directed by the results of Sahbaz and Kocer (2017), who affirmed that the presence ofchildren with special needs did not affect the burnout level of caregivers. Conversely, the results
were different from those of Kiso (2013) and Yoshikane and Hayashi (2010) and other studies
conducted in Japan, which argued that burnout was affected when caring for developmentallydisabled children or children with developmental tendencies (Kiso, 2013; Yoshikane and Hayashi,2010). In Japan, it has been reported that approximately 80% of nursery schools have children withspecial needs (MHLW, 2019b), and it is expected that children with disabilities and developmental
disabilities, even among those with special needs, are now expected to spend time together in regularclasses. Since the Salamanca Declaration, there has been a change in the awareness of nursery school─ 30 ─

Journal of Developmental Disabilities Research No. 1

teachers toward inclusive education and research on the practice in Japan (Hori, 2017). We believethat this may be because nursery school teachers have accumulated knowledge about disabilities andchildcare practices that are no longer directly connected to SSIE and J-MBI.
Contrarily, there was a significant difference between the SSIE subscales “human relations withparents and other children in the class” and “insufficient self-expertise” and the experience of caring
for children with medical care needs. In Japan, since Act for Eliminating Discrimination against
Persons with Disabilities in 2016, the Child Welfare Law has been amended, and the number ofchildren requiring medical care in nursery schools has increased dramatically (MHLW, 2020b).
According to a case study on children with medical care who use nursery schools, the inclusion ofchildren with medical care needs, children with disabilities, and healthy children in a class brings out
diverse needs and increases the number of difficult situations for day-care practices (Ueda et al.,2020). In addition, according to a questionnaire survey of nurses at nursery school caring for children
who require medical care, training for nursery school teachers is necessary because nursery school
teachers are currently providing medical care together with nurses (Sorata, 2014). The burden andrisk of providing safe and secure medical care in a non-medical nursery school is great, and theimportance of supporting nursery school teachers in dealing with tension and accidents is required(Ueda et al., 2020). As revealed in the results of the present research, there are many nursery school
teachers who have no experience with the need for medical care in nursery schools, and childcare
practices and issues involving children with medical care have not been sufficiently accumulated(Matsumoto et al., 2019). Thus, the entire preschool must establish a system to prevent the burden
from becoming too great only on the nursery school teachers who oversee children with medicalcare, to accumulate childcare practices, and to improve the skills of nursery school teachers byenhancing training. It has also been elucidated that there is a chronic shortage of nurses in nurseryschools and that they do not adequately accept children who require medical care (Sorata, 2014).
Deciding for the placement of not only nursery school teachers but also nurses is crucial.
Similarly, there was a significant difference between the childcare experience of children
requiring language support due to foreign nationality and J-MBI’s “decreased sense of personal
accomplishment.” Hayashi (2021) affirmed that in caring for children who need language support due
to their foreign nationality, understanding the difficulties of communication with children and parents
and their culture is necessary. This is not a problem that can be solved by simply communicating in
the language, but it is expected that the inability to communicate due to differences in the mothertongue leads to a decrease in the sense of personal accomplishment of the nursery school teachers.
There are some reports that translation and dissemination applications are used to supplement
linguistic communication with parents, but there is a large disparity in the dispatch of interpreters
among local governments, and the actual situation is that it is left to the efforts of the nursery school
teachers to respond (Hayashi, 2021). In a national survey report, the following issues were also
identified as challenges in caring for children with foreign nationality: “It is difficult to communicate
the detailed nuances of concerns to parents” and “It is difficult to understand the specific problems
and needs of children with foreign roots and their parents” (MHLW, 2019a). This suggests that it is
not a problem that can be solved simply by being able to communicate in a language, but that theinability to communicate due to differences in native languages leads to a decline in the personalsense of accomplishment of nursery school teachers. In the future, utilizing foreign nursery school
teachers who understand multicultural childcare, accumulating practical experience in the childcare
field, and training nursery school teachers in multicultural understanding and communication will beessential.
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Journal of Developmental Disabilities Research No. 1

According to Fukushima and Shimizu (2017), who examined knowledge about developmental
disabilities and the factors that influence burnout among nursery school teachers, it was noted thatthe level of knowledge about developmental disabilities depends on whether nursery school teachers
are aware of it or not. In this study, the importance of the balance between personal knowledge andsocial support is highlighted as stress is higher when nursery school teachers’ knowledge of inclusive
education is high but social support from colleagues in the workplace is low(Fukushima and Shimizu,2017). The importance of balancing personal knowledge and social support is affirmed. In addition,
Friedman-Krauss et al. (2014) asserted that teachers who reported higher levels of child behavior
problems also reported higher levels of stress from their work and that this relationship was
statistically significant. This relationship is statistically significant (Friedman-Krauss et al, 2014).
Therefore, future research should focus on nursery school teachers who feel strongly about SSIE andadditionally investigate the reasons for this and their working environment.
4.2

Related models of SSIE, J-MBI, J-WHO-5, and J-RAS
The relationship between SSIE, which is a stressor in caring for children with special needs,
J-MBI and J-WHO-5, which are stress responses, and J-RAS, which is a personal factor, wasanalyzed by covariance structure analysis. Additionally, the relationship between SSIE, a stressor incaring for children with special needs, the stress responses, J-MBI and J-WHO-5, and the personal
factor, J-RAS, was analyzed by covariance structure analysis. The results confirmed that although
SSIE directly affected burnout, there was no direct path between SSIE and J-WHO-5. In addition, a
direct path was found from J-RAS to the stressors insufficient self-expertise and mental health. Thissuggests that an increase in the assertiveness total score may reduce the stressor, increase mental
health, and reduce burnout tendencies. This result supported a study by Jovanović et al. (2019),
which examined the special needs of teachers working with children with developmental disabilities,
and the assertiveness level is a stressor and stress response to burnout and mental health. It was
found to be one of the personal factors that influence (Jovanović et al, 2019).
4.3

Mental health and assertiveness of nursery school teachers
It is worth noting that 181(60.33%) of the nursery school teachers were considered to have poor
mental health, with an overall mean of 12.82 (SD = 5.28) in J-WHO-5. In Japan, there is a serious
problem of early turnover and shortage of nursery school teachers (Kiso, 2018). Stress and burnout
among nursery school teachers are problems in many countries (Grant et al., 2019; Lim and Kim,
2014), and efforts to reduce the burden on nursery school teachers and create a comfortable work
environment are required. In addition, according to a study conducted by the OECD in 2020, nurseryschool teachers are more likely to feel stressed when the percentage of children with special needs
exceeds 11% of the class (OECD, 2020). The results of the present study corroborated that
employment condition part-time employees are more likely to suffer from emotional exhaustion on
the burnout scale compared with full-time employees. These hard aspects, such as the number ofchildren, working conditions, and environment, cannot be improved by individual nursery school
teachers. Efforts to improve mental health should not be left to the efforts of individual nurseryschool teachers but should include a preschool-wide support system, training initiatives, working
conditions, and class sizes.
I would also like to discuss the assertiveness scores of nursery school teachers. The mean
assertiveness score of the nursery school teachers was −3.49 (SD: 0.97). The higher the J-RAS score,
the higher was the value of mental health. Conversely, a study of nurses indicated that a J-RAS
─ 32 ─

Journal of Developmental Disabilities Research No. 1

score of −10 to +10 was unlikely to lead to burnout, and that too high a score can also lead toburnout (Suzuki et al., 2006). Suzuki et al. (2007), who investigated the relationship between
assertiveness and burnout among new nurses, argued that a J-RAS score of 10 to +10 was less likely
to lead to burnout (Suzuki et al., 2007). Nevertheless, it has been highlighted that nurses have very
low assertiveness scores because they are required to act as a mediator between doctors andpatients and because they are in a profession where medical accidents directly affect human lives(Suzuki et al., 2017). Accordingly, comparing the assertiveness scores of nurses and nursery school
teachers is difficult. As there have been very few studies on assertiveness in nursery school teachers(Shiratori et al., 2021), a comparative study on mental health and burnout is an area for future
investigation.
4.4

Limitations of this study and future issues
It is good to note that by using an online questionnaire, we were able to obtain responses fromall 47 prefectures, covering all nursery school teachers. However, a certain amount of bias must be
considered as the target audience was users registered as monitors with the research company.
Since it has been pointed out that it is very difficult to accurately grasp the concerns in promoting
inclusive childcare (Park et al., 2018), cross-sectional surveys have their limitations. It is important to
conduct additional research, such as interviews, on the relationship between stress among nurseryschool teachers and caring for children with special needs and stress among nursery school teachers.
Let us talk about future issues. Assertiveness is strongly associated with self-trust, selfdisclosure, etc., and is deeply related to stress in interpersonal relationships (Hiraki, 1993). According
to Park et al. (2018), early childhood teachers’ concerns about inclusive education are mediated byteachers’ background variable “confidence,” and training to improve confidence is of paramountimportance(Park et al., 2018). This is the most important factor. The acquisition of assertive
communication is expected to lead to self-belief and self-confidence, which, in turn, will improve themental health of nursery school teachers. Assertion training for nursery school teachers in the future
must be developed as there have been no research reports on assertion training for nursery school
teachers in Japan.
Statements and declarations
Competing interests
The authors have no relevant financial or nonfinancial interests to disclose.
Funding
Funding was provided by the Mitsubishi Foundation.

References
Aboagye, M. O., Qin, J., Qayyum, A., Antwi, C. O., Jababu, Y. & Affum-Osei, E. (2018). Teacher burnout inpre-schools: A cross-cultural factorial validity, measurement invariance and latent mean comparison of theMaslach Burnout Inventory, educators survey (MBI-ES). Children and Youth Services Review, 94, 186–197.
https://doi.org/10.1016/j.childyouth.2018.09.041.
Akada, T. (2010). Hoikusi sutoresuhyoteisyakudonosakuseito sinraisei･datoseinokento:[Nursery Teacherʼs Stress Scale (NTSS): Reliability and validity]. Japanese Journal of Psychology, 81, 158–166.
(in Japanese)─ 33 ─

Journal of Developmental Disabilities Research No. 1

Akagawa, Y. & Kimura, N. (2019). Hoikusino syokubasutoresunikansurukenkyu-kyukeizikan･motikaerisigotok
aranokento: [Research on childcare workers’ stress at the workplace: Break time duration and take-homework]. Japan Society of Research on Early Childhood Care and Education, 57, 56–66. (in Japanese)
Awata, S., Bech, P., Yoshida, S., Hirai, M., Suzuki, S., Yamashita, M., Ohara, A., Hinokio, Y., Matsuoka, H. &Oka, Y. (2007). Reliability and validity of the Japanese version of the World Health Organization-Five WellBeing Index in the context of detecting depression in diabetic patients. Psychiatry and Clinical
Neurosciences, 61, 112–119. https://doi.org/10.1111/j.1440-1819.2007.01619.x.
Bureau of Social Welfare and Public Health, Tokyo. (2018). Heisei 30 nendo toukyouto hoikusi jitai tyosakekka (houkokusyo): [Results of the FY 2008 Survey of Tokyo Metropolitan Government’s Nursery School
Teachers (Report)]. Retrieved from https://www.fukushihoken.metro.tokyo.lg.jp/kodomo/
shikaku/30hoikushichousa.files/430chosakekkashosai.pdf. (in Japanese) (accessed 2023-4-11).
Daigo, M., Shitara, M., Yamazaki, S. & Ishizaki, Y.(2010)．Seisinka na-suno asasyonto
syokubasutoresunokanren: [Connection with Assertion and the Occupational Stress of the Psychiatric
Nurses]. The Japan Academy of Psychiatric and Mental Health Nursing，19, 155–160. (in Japanese)
Faulkner, M., Gerstenblatt, P., Lee, A., Vallejo, V. & Travis, D. (2016). Childcare providers: Work stress andpersonal well-being. Journal of Early Childhood Research, 14, 280–293. https://doi.org/10.1111/j.14401819.2007.01619.x.
Friedman-Krauss, A. H., Raver, C. C., Morris, P. A. & Jones, S. M. (2014). The role of classroom-level childbehavior problems in predicting preschool teacher stress and classroom emotional climate. Early Education
and Development, 25, 530–552. https://doi.org/10.1080/10409289.2013.817030.
Fukushima, K. & Shimizu, H. (2017). Hoikusinobān’auto nieikyowoyobosuyoinnokento-hattatusyogai
nikansurutisiki nityakumokusite: [Factors affecting burnout in nursery teachers-focusing on knowledge ofdevelopmental disabilities-]. The Annual Research on Early Childhood, 39, 13–22. (in Japanese)
Grant, A. A. Jeon, L. & Buettner, C. K. (2019). Chaos and commitment in the early childhood education
classroom: Direct and indirect associations through teaching efficacy. Teaching and Teacher Education, 81,
50–60. https://doi.org/10.1016/j.tate.2019.02.010.
Hayashi, Y. (2021). Gaikokunirunagaru kodomonohoikuniokeru kateitonorenkei nokadai:kodomonogengohattatu
nositenkara: [Issues in cooperation between early childhood educators and families of children with diverse
cultural backgrounds: Focusing on children’s language development]. Journal of Kobe Shoin Womenʼs
University, 2, 67–81. (in Japanese)
Hiraki, N. (1993). Asashon・toreningu-sawayakana〈jikohyogen〉notameni: [Assertion training-for smooth
self-expression]. Kaneko Shobo. (in Japanese)Hori, T. (2017). Inkurushibuhoiku noigito sonojissenjonokadai: [The significance of inclusive education and its
practical issues]. Japan Society of Research on Early Childhood Care and Education, 55, 84–99. (in Japanese)
Ikeda, Y., Okawa, I. (2012). Hoikushi・youtienkyoyuno sutoresa-ga syokumunitaisuru seisinjyotainioyobosueikyo: [The Relation between Day Nursery and Preschool Teachers’ Thoughts about Job
Stessors and Their Mental State Regarding Work: Work Duties and Work Environment as Mediating
Factors]. The Japanese Journal of Developmental Psycology, 23, 23–35. (in Japanese)
Jobe, D., Rust, J. O. & Brissie, J. (1996). Teacher attitudes toward inclusion of students with disabilities into
regular classrooms. Education, 117, 148–154.
Jovanović, V., Karić, J., Mihajlović, G., Džamonja-Ignjatović, T. & Hinić, D. (2019). Work-related burnout
syndrome in special education teachers working with children with developmental disorders—Possible
correlations with some socio-demographic aspects and assertiveness. European Journal of Special Needs
Education, 34, 692–701. https://doi.org/10.1080/08856257.2019.1572092.
Kiso, Y. (2013). Hattatusyogaino keikogaarukodomoto hoikusinobanautonokankei-situmonsityosayori: [The─ 34 ─

Journal of Developmental Disabilities Research No. 1

relationship between the number of children with suspected developmental disorders and burnout innursery school teachers: A cross-sectional postal survey]. Japan Society of Research on Early Childhood
Care and Education, 51, 199–210. (in Japanese)
Kiso, Y. (2016). Misindanno hattatusyogainokeikogaarukotomono hoikuyahogosyasiento hoikusinosinritekihuta
ntonokankei-banautosyakudowomotiitasitumonsityosayori: [The relationship between day nursery teachers’
psychological burdens and bringing up children with characteristics of developmental disorders or
supporting their parents: A cross-sectional survey using the burnout scale]. Japan Society of Research on
Early Childhood Care and Education, 54, 67–78. (in Japanese)
Kiso, Y. (2018). Misindanno hattatusyogainokeikogaarukotomono hoikuyahogosyasiento hoikusinosinritekihuta
ntonokankei-banautosyakudowomotiitasitumonsityosayori: [Research trends of early turnover of nurseryschool and kindergarten teachers: Focusing on the actual conditions, factors, and prevention methods].
Journal of Social Problems, 67, 11–22. (in Japanese)
Kubo, M. & Tao, M. (1992). Banautonosokutei [Burnout: Concepts and methods]. Japanese Psychological
Review, 35, 361–376. (in Japanese)Lim, N.-J. & Kim, A.-N. (2014). Effects of early childhood teacher job stress on the turnover intention and job
satisfaction. Journal of the Korea Academia-Industrial Cooperation Society, 15, 4972–4980. https://doi.
org/10.5762/KAIS.2014.15.8.4972.
Maslach, C. & Jackson, S. E. (1981). The measurement of experienced burnout. Journal of Organizational
Behavior, 2, 99–113. https://doi.org/10.1002/job.4030020205.
Matsumoto, Y., Sasakawa, T., Ueda, K., Mikami, F., Sugimoto, A. & Suemitsu, S. (2019).
Nihonniokeruiryotekikeazino hoikusisetuhenokeirenikansurukenkyenodoko: [Study of inclusive support fortechnology-dependent children and their families at a nursery school in Japan]. Kawasaki Medical Welfare
Journal, 29, 9–19. (in Japanese)
Ministry of Education, Culture, Sports, Science, and Technology. (2017). Kyosyokukateikoakarikyuramu:[Teacher training core curriculum]. Retrieved fromhttps://www.mext.go.jp/content/20210730-mxt_kyoikujinzai02-000016931_5.pdf. (in Japanese) (accessed 20234-11).
Ministry of Health, Labour and Welfare. (2015).「Hoikushikakuhopuran」nokouhyou: [Publication of “Plan for
Securing Nursery School Teachers”]. Retrieved from https://www.mhlw.go.jp/file/04-Houdouhappyou11907000-Koyoukintoujidoukateikyoku-Hoikuka/0000070942.pdf. ( in Japanese) (accessed 2023-4-11).
Ministry of Health, Labour and Welfare. (2019a). Hoikusyotoniokerugaikokusekinokodomo･hogosyahenotaionik
ansuru tyosakenkyuzigyohokokusyo: [Handling of foreign children and their parents in day-care centers,
etc. Research and study on how to deal with children and their parents research and study project report].
Retrieved from https://www.mhlw.go.jp/content/11900000/000756538.pdf. (in Japanese) (accessed 2023-411).
Ministry of Health, Labour and Welfare. (2019b). Syogaikokuniokeru hoikunositunotoraekata･simesikatanikans
urukenkyukai: [Study group on how to understand and show the quality of childcare in other countries].
Retrieved fromhttps://www.mhlw.go.jp/content/11907000/000533050.pdf. (in Japanese) (accessed 2023-4-11).
Ministry of Health, Labour and Welfare. (2020). iryotekikeajitono shiennikakarushisakunodoko: [Trends inpolicies to support children in medical care]. Retrieved from https://www.mhlw.go.jp/
content/10800000/000584473.pdf. (in Japanese) (accessed 2023-4-11).
Ministry of Health, Labour and Welfare. (2022). Hoikusyotoukanrenjyoukyou torimatome: [Summary of thesituation related to daycare centers, etc]. Retrieved from https://www.mhlw.go.jp/
content/11922000/000979606.pdf. (in Japanese) (accessed 2023-4-11).
─ 35 ─

Journal of Developmental Disabilities Research No. 1

Organization for Economic Co-Operation and Development. (2020). Education at a glance: Educational
attainment and labour-force status. Retrieved from https://www.oecd.org/publications/providing-qualityearly-childhood-education-and-care-301005d1-en.htm. (accessed 2023-4-11).
Park, M.-H., Dimitrov, D. M. & Park, D.-Y. (2018). Effects of background variables of early childhood teachers
on their concerns about inclusion: The mediation role of confidence in teaching. Journal of Research inChildhood Education, 32, 165–180. https://doi.org/10.1080/02568543.2017.1417926.
Japan Council for Childcare Issues. (2021, June 25). Hoikunohoikunonakano「tayosei」toha? inkurushibugamot
omerareruimawokangaeru: [What is “diversity” in childcare? Considering the current need forinclusiveness]. Quarterly Journal of Conservation Studies, 309, 84–89. (in Japanese)
Rathus, S. A. (1973). A 30-item schedule for assessing assertive behavior. Behavior Therapy, 4, 398–406.
https://doi.org/10.1016/S0005-7894(73)80120-0.
Sahbaz, U. & Kocer, N. K. (2017). A comparison of burnout levels of preschool teachers in terms of having
integration students in their classes or not. Educational Research and Reviews, 12, 350–355.
Sharma, U. & Desai, I. (2002). Measuring concerns about integrated education. Asia Pacific Journal on
Disability, 5, 2–14.
Shiratori, M. & Kojima, M. (2022). Factor Structure and Psychometric Properties of the Stressor Scale in
Inclusive Education in Nursery School Teachers of Children With Special Needs in Japan: The Relationship
Between Assertiveness and Stress.Frontiers in Education, 29. https://doi.org/10.3389/feduc.2022.761679
Shiratori, M., Saito, K. & Kojima, M. (2021). Hoikushanikansuru asashonkenkyunodokototembo: [Trends andprospects for assertion research on preschool teachers]. Bulletin of Teikyo Junior College, 22, 55–63. (inJapanese)
Sorata, T. (2014). Iryotekikeagahitsuyonakodomowoyoikusuru hogoshanohoikuen・yochiennoriyojittaitonizu:[The actual situation of support for children requiring medical care and Nurse’s awareness in nurseryschool]. Academic Archives of Yamaguchi Prefectural University, 7, 57–63. (in Japanese)Štemberger, T. & Kiswarday, V. R. (2018). Attitude towards inclusive education: The perspective of Slovenianpreschool and primary school teachers. European Journal of Special Needs Education, 33, 47–58. https://doi.
org/10.1080/08856257.2017.1297573.
Suzuki, E., Kanoya, Y., Ishida, S., Katsuki, T. & Sato, C. (2004). Nihongoban Rathus assertiveness schedulekaihatunikansurukenkyu: [The development of the Japanese version of the Rathus Assertiveness Schedule].
Japanese Society of Human Science of Health-Social Services, 10, 19–29. https://doi.org/10.20681/
hwelfare.10.2_19. (in Japanese)
Suzuki, E., Kanoya, Y., Ishida, S., Katsuki, T. & Sato, C. (2006). Assertiveness affecting burnout of novice
nurses at university hospitals. Japan Journal of Nursing Science, 3, 93–105. https://doi:10.1111/j.17427924.2006.00058.x
Suzuki, E., Kanoya, Y., Katsuki, T. & Sato, C. (2007). Verification of reliability and validity of a Japaneseversion of the Rathus assertiveness schedule. Journal of Nursing Management, 15, 530–537. https://doi.
org/10.1111/j.1365-2834.2007.00691.x
Suzuki, E., Takayama, Y., Maruyama, A., Azuma, T., Tomita, S., Yamamoto, T. & Sato. (2017).
Joseishinsotsukangoshino asate bunesushakudonokaihatsu: [Development of a Female Novice Nurse
Assertiveness scale]. Japan Academy of Nursing Science, 37, 193–201. (in Japanese)
Takagi, R. & Tanaka, K. (2003). Kyoshinoshokugyosutoressanikansurukenkyu-kyoshinoshokugyosutoressato
ban-autonokankeiwochushinni: [Occupational stress and burnout in elementary and middle school teachers].
Japanese Journal of Educational Psychology, 51, 165–174. https://doi.org/10.5926/jjep1953.51.2_165 (inJapanese)
Takata, J. (2009). Shogainoarujidono tanninkyoshinoban-autokeiko,shokubakankyosutoressa,
─ 36 ─

Journal of Developmental Disabilities Research No. 1

tokubetsushienkyoikufutankan, jikokoryokukan: [Association of burnout tendency with job environmental
stressors, burden in special needs education, and self-efficacy among elementary school teachers withclasses including handicapped pupils]. Journal of School Menta1 Health, 12, 53–60. (in Japanese)
Tasic, R., Rajovic, N., Pavlovic, V., Djikanovic, B., Masic, S., Velickovic, I., Mostic, D., Milcanovic, P., Janicijevic,
V., Stanisavljevic, D. & Milic, N. (2020). Nursery teachers in preschool institutions facing burnout: Are
personality traits attributing to its development? PloS One, 15, https://doi.org/10.1371/journal.pone.0242562
Ueda, K., Mikami, F., Matsumoto, Y., Sugimoto, A., Suemitsu, S. & Sasakawa, T. (2020). Iryotekikeajito sonokaz
okuhenoinkurushibunashiennojissaitokadai-hoikushoworiyosuruiryotekikeajinokesusutadeikara-: [Study ofinclusive support for technology-dependent children and their families at a nursery school in Japan]].
Kawasaki Journal of Medical Welfare, 30, 47–59. (in Japanese)
United Nations Educational, Scientific and Cultural Organization. (1994). The Salamanca statement andframework for action on special needs education. Retrieved fromhttps://www.right-to-education.org/sites/right-to-education.org/files/resource-attachments/Salamanca_
Statement_1994.pdf
Yaginuma-Sakurai, K., Tsuno, K., Yoshimasu, K., Maeda, T., Sano, H., Goto, M. & Nakai, K. (2020). Psychologicaldistress and associated factors among Japanese nursery school and kindergarten teachers: A crosssectional study. Industrial Health, 58, 530–538. https://doi.org/10.2486/indhealth.2020-0052
Yoshikane, N. & Hayashi, T. (2010). Tokubetsushienkyoikujidainiokeru hoikushinogyomujono hoikukonnankan:[About difficulties in child care faced by nursery teacher in the age of special needs education]. Academic
Archives of Yamaguchi Prefectural University Bulletin and Records of Research Activities, 3, 81–87. (inJapanese)─ 37 ─

［Paper］

Relationship between Contingencies of Self-Worth, Contentment of
Sources of Self-Worth, and Subjective Well-Being of Japanese People
with Autism Spectrum Disorder
Shuhei Ogawa

Research Fellow, Japan Society for the Promotion of Science

Michio Kojima

Faculty of Human Sciences, University of Tsukuba

Abstract
The study examined the relationship between contingencies of self-worth, contentment ofsources of self-worth, and subjective well-being of Japanese adults with autism spectrum disorder(ASD), through a comparison with adults in the same age group. For this purpose, a questionnaire
survey was administered to a sample of 19 adults with ASD and 50 adults in the same age group (thecontrol group). The results showed that “friendships” and “enthusiastic activity” of the participants
with ASD were higher than those of the control group in terms of contingencies of self-worth andcontentment of sources of self-worth. In addition, no significant correlations were found for the subfactors of contingencies of self-worth and subjective well-being among the adults with ASD. The
higher contentment of sources of self-worth, “athletic competence,” and “friendships,” the higher
subjective well-being of the adults with ASD. The implication of the findings is that enhancing“athletic competence” and “friendships” in contentment of sources of self-worth may be effective for
improving subjective well-being of adults with ASD.
Keywords: Autism spectrum disorder, Contingencies of self-worth, Contentment of sources of selfworth, Self-esteem, Subjective well-being

1.

Introduction

Self-esteem has been defined as the positivity of overall evaluative feelings toward oneself (Endo,2013). The perspectives from which self-esteem can be analyzed include contingencies of self-worth(CSW) and contentment of sources of self-worth (CSSW). The former refers to the concept of what
domains take self-esteem and the estimates of one’s own worth (Crocker et al., 2002; Crocker et al.,
2003; Uchida, 2008). As for the latter, ＊1 it has been defined as an indicator of how satisfied thesources of self-esteem are (Ito et al., 2013).
Previous research has shown that CSW are related to motivation (Ohtani, 2012). Since people are
more likely to be motivated toward objects with high CSW, they will actively engage in them,
resulting in a higher CSSW. For example, those for whom athletic competence is a source of selfesteem (i.e., CSW in athletic competence are high) will actively engage in exercise. They will tend to
be more athletic (i.e., CSSW in athletic competence is high), and self-esteem is likely to increase.
However, those for whom athletic competence is not a source of self-esteem (i.e., CSW in athletic─ 38 ─

Journal of Developmental Disabilities Research No. 1

competence are low) will not actively engage in exercise. They will not tend to be more athletic, andself-esteem is not likely to increase. In this regard, self-esteem can be clarified by not only
considering it in terms of high and low self-esteem, but also by focusing on CSW and CSSW.
As for the relationship between self-esteem and various constructs, one construct with aparticularly strong relationship is subjective well-being. Previous research has defined subjective
well-being as “a broad category of phenomena that includes people’s emotional responses, domain
satisfactions, and global judgments of life satisfaction” (Diener et al., 1999). Subjective well-being canalso be divided into two domains: cognitive and affective (Diener et al., 1999). The cognitive aspectrefers to the degree of satisfaction with one’s life (Ito et al., 2003) and is the core concept of subjective
well-being (Gilman and Huebner, 2006). On the other hand, the affective aspect consists of both
positive and negative emotions such as enjoyment and sadness (Ito et al., 2003).
Baumeister et al. (2003) found a strong relationship between subjective well-being and selfesteem, with higher self-esteem leading to higher subjective well-being. Ito and Kodama (2005)
considered that a dispositional cognitive style that views aspects in a positive light can result in apositive perception of both the present self and life.
Autism spectrum disorder (ASD) is a disorder related to social communication. Due to its
negative psychological aspects, a number of people with ASD have been diagnosed with depressive
symptoms or mental disorders in adolescence and adulthood (Kikuchi, 2010). Recent research has
begun to examine the positive psychological aspects of subjective well-being among people with
ASD, rather than the negative ones. For instance, Scheeren et al. (2022) conducted a longitudinal
study of subjective well-being of 917 individuals with ASD over a six-year period. They found thatthe higher the objective psychosocial functioning is, such as employment, independent living, andfriendship ratings, the higher subjective well-being is.
Studies of subjective well-being have also begun to be conducted on Japanese individuals with
ASD. For example, Kojima (2018) compared the high and low subjective well-being of 27 students/
working adults with ASD and 60 people in the same age group, and found little difference. They also
found that the higher self-esteem of those with ASD, the higher their subjective well-being. This
indicates the effectiveness of self-esteem support for enhancing subjective well-being of individuals
with ASD.
Although self-esteem of adults with ASD has been reported to be lower or similar than that oftypically developing adults, the findings have been inconsistent (e.g., Maras and Bowler, 2012; Nguyen
et al., 2020). The reason may be due to individual differences among people with ASD (Kojima andNoutomi, 2013). Given the possibility that self-esteem of adults with ASD is lower or similar to thatof typically developing adults, and the possibility of individual differences, it is likely that there are anumber of adults with ASD who need self-esteem support. However, it is unclear how to provide
such support. Previous research (Kojima, 2018) on self-esteem and subjective well-being ofindividuals with ASD has only examined the relationship between these two aspects, leaving thisissue open to discussion. Thus, it is important to clarify CSW and CSSW, which are two perspectives
from which self-esteem can be analyzed in more detail.
In previous studies on CSW, they used developmentally appropriate scales. For example, studies
conducted on adolescents (Ohtani and Nakaya, 2010) used the CSW Scale for adolescents, while those
for adults (Crocker et al., 2003; Uchida, 2008) used the CSW Scale for adults. In the present study, weonly target adults with ASD who may have lower or similar self-esteem than typically developing
adults.
By examining the relationship between CSW, CSSW, and subjective well-being, we can clarify
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the relationship between self-esteem and subjective well-being among adults with ASD. We hope togain insight into how to help such adults lead more fulfilling lives through self-esteem support.
Therefore, this study examined the relationship between CSW, CSSW, and subjective well-being ofJapanese adults with ASD, through a comparison with adults in the same age group.

2.

Method2.1

Subjects
In order to recruit a sample of adults with ASD, requests were made to 13 parent associations ofchildren and persons with developmental disabilities in Japan, after which cooperation was obtained
from eight such associations. For each association, we asked the person in charge to send a lettercontaining the URL and QR code of the questionnaire to their members via e-mail. While answering
the questionnaire, we basically asked the respondents to assume what they would answer in person.
Overall, we received 30 responses. After excluding the data with missing values, the number of
respondents with ASD (without intellectual disabilities) was 19 (18 males; 1 female). Among them, 5
had coexisting ADHD and 2 had coexisting ADHD and LD. Their ages ranged from 20 to 57 years,
with a mean age of 27.2 years (SD = 8.2).
For the control group, which consisted of a sample of adults in the same age range, an online
survey was conducted by Cross Marketing Inc. The ages of the 50 adults (45 males; 5 females)
ranged from 19 to 57 years, with a mean age of 25.5 years (SD = 6.2). A t-test was also performed on
the ages of the adults with ASD and the control group, after which no significant differences were
found (t (67) = 0.95, p > .05). Thus, the ages of the adults with ASD and those of the adults in thecontrol group were similar.
2.2

Survey period
This research was conducted from June 2022 to September 2022.

2.3 Questionnaire
2.3.1 Information sheet
For the adults with ASD, they were asked to state their gender, age, occupation, and diagnosis.
For the control group, they were asked to provide their gender, age, and occupation.
2.3.2 CSW and CSSWIn this study, the self-developed CSW Scale and CSSW Scale for adults were used. Both scales,
which have shown reliability and validity, consist of five factors: athletic competence, enthusiastic
activity, friendships, prosocial behavior, and appearance. Both scales were also created incorrespondence with one another. For example, the item “I am satisfied with myself when I can treat
people with compassion” on the CSW Scale corresponds to “I think I treat people with compassion”
on the CSSW Scale (Table 1). The responses to the CSW Scale were based on a six-point scaleranging from 1 (not applicable at all) to 6 (very applicable), while the answers to the CSSW Scale
were based on a five-point scale ranging from 1 (not applicable at all) to 5 (very applicable). Before
developing the scales for adults with ASD, one representative of the association of parents ofchildren and persons with developmental disabilities was asked to evaluate the contents, after which
the questionnaire items were modified based on the opinions.
2.3.3 Subjective well-being
This study also used the Subjective Well-Being Scale (Ito et al., 2003), based on the World Health─ 40 ─

Journal of Developmental Disabilities Research No. 1

Table 1The Contingencies of Self-Worth Scale and the Contentment of Sources of Self-Worth Scale

The Contingencies of Self-Worth Scale

The Contentment of Sources of Self-Worth Scale

Athletic competence

Athletic competence88Have good motor skills is important to me

11I get depressed when I don’t achieve good 11
results in sports

I think I achieve good results in sports

14

Being good at sports makes me confident

I think I am good at sports

14

I think I have good motor skills

Enthusiastic activity

Enthusiastic activity

4

I t is important for me to work on things thatinterest me

4 I think I am working on something I am
interested in7I am satisfied with myself because I havesomething to devote myself to

7

15

I feel confident when I am enthusiastic about 15
something I likeI think I have something to devote myself to
I think I am enthusiastic about what I like

Friendships

Friendships2

I f I don’t have friends I can talk to about
anything, I don’t feel confident about myself

2

I have friends with whom I can talk about
anything

5

I don’t mind if I don’t have good friends＊

5

I don’t think I have any good friends＊

13

I t is important for me to have friends whom I 13
can trustI think I have friends I can trust

Prosocial behavior

Prosocial behavior

1

I feel confident when I can be kind to others

1

I think I am kind to people3

I am satisfied with myself when I can treat
people with compassion

3

I think I treat people with compassion

10

Doing things for others is important to me

10

I think I do things for others

Appearance

Appearance

6

Good looks is important to me

6

I think I have good looks

9

I lose self-confidence if I feel I have a bad body
figure (style)9

I think have a good figure (style)12I am satisfied with myself if I think I have a cool 12(beautiful) face

I think I have a cool (or beautiful) faceNote. ＊Item was reversed scoring.

Organization’s Subjective Well-Being Inventory (Sell and Nagpal, 1992). The adult version of thisscale consisted of one factor and 12 items, with demonstrated reliability and validity (Ito et al., 2003).
The answers were based on a four-point scale, with higher scores indicating a higher subjective
well-being.
2.4

Ethical considerations
For the adults with ASD, this study was conducted with the consent of the representative of theparent association and that of the individual. For the control group, we obtained the consent of eachparticipant. When conducting the survey, the author explained (in writing) that the survey would be
conducted based on the free will of the survey respondents, that there would be no disadvantage ifthey did not respond, and that privacy protection would be ensured. In addition, the research was─ 41 ─

Journal of Developmental Disabilities Research No. 1

Table 2

 ontingencies of self-worth, contentment of sources of self-worth, and subjective well-being ofCadults with ASD and control group
Adults with ASD

Control groupMedian (interquartile range)

Median (interquartile range)

3. 33 (1. 33)

3. 67 (1. 42)prContingencies of self-worth
Athletic competence
Enthusiastic activity

5. 00 (1. 67)

0. 74

4. 00 (1. 75)

0. 02

＊
＊

0. 04
0. 29
0. 29

Friendships

4. 33 (1. 67)

3. 67 (0. 75)

0. 02

Prosocial behavior

4. 67 (1. 67)

4. 00 (2. 00)

0. 44

0. 09

Appearance

3. 67 (1. 33)

4. 00 (1. 08)

0. 78

0. 03

Contentment of sources of self-worth
Athletic competence

2. 33 (1. 00)

2. 33 (1. 67)

0. 25

0. 14

Enthusiastic activity

4. 00 (1. 00)

3. 33 (1. 08)

0. 01＊＊

0. 32

†

0. 24

Friendships

3. 67 (1. 67)

3. 00 (1. 42)

0. 05

Prosocial behavior

3. 33 (1. 67)

3. 33 (1. 42)

0. 82

0. 03

Appearance

2. 33 (1. 67)

2. 50 (1. 33)

0. 19

0. 16

2. 42 (0. 83)

2. 67 (0. 75)

0. 53

0. 08

Subjective well-being＊＊

p < . 01,

Table 3＊p < . 05,†

p < . 10.

Spearman’s rank correlation coefficients for the sub-factors of contingencies of self-worth andsubjective well-being
Contingencies of self-worth
Athletic
Enthusiastic
Prosocial
Friendships
competence
activity
behavior

Adults with ASD
Control group

Subjective well-being

-. 35

-. 03

. 05

. 48

. 08
＊＊

. 01

. 14
＊

. 33

Appearance
-. 17
. 06

＊＊

p < . 01, ＊p < . 05.

conducted with the consent of the research ethics committee of the graduate school to which theauthor belongs (2022-71A; June 9, 2022).
2.5

Analysis
SPSS (version 28) and Excel programs were used to analyze the statistics.

3.

Results

3.1

Basic statistics for each scale and the results of the Mann-Whitney U test
The Mann-Whitney U test was conducted on the scores of each scale for the adults with ASD
and the control group (Table 2). According to the results, the scores for “enthusiastic activity” (p <.05) and “friendships” (p < .05) in CSW were significantly higher for the adults with ASD than for thecontrol group. CSSW was also significantly higher for the adults with ASD than the control group in“enthusiastic activity” (p < .01). In addition, there was a significant trend in the score for “friendships”(p < .10) in CSSW and no significant difference in subjective well-being.

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Table 4

 pearman’s rank correlation coefficients for the sub-factors of contentment of sources of self-worthSand subjective well-being
Contentment of sources of self-worth
Athletic
Enthusiastic
Prosocial
Friendships
competence
activity
behavior

Adults with ASD
Control group  . 46＊

Subjective well-being

. 16

. 49＊

. 24
＊＊

. 48

. 36

. 34

＊

Appearance
. 36

＊＊

. 40

. 17

＊＊

p < . 01, ＊p < . 05.

Table 5

Spearman’s rank correlation coefficients for the sub-factors of contingencies of self-worth andcontentment of sources of self-worth

Adults with ASD
Control group＊＊p < . 01,＊

Athletic
competence

Enthusiastic
activity

Friendships

Prosocial
behavior

Appearance-. 05. 70＊＊

. 49＊

. 37

-. 07

. 52＊＊. 73＊＊

. 25

. 74

＊＊

. 57

＊＊

p < . 05.

3.2

Relationship between CSW, CSSW, and subjective well-being
Spearman’s rank correlation coefficients were calculated for the sub-factors of CSW andsubjective well-being for the adults with ASD and the control group (Table 3). No significant
correlations were found for the sub-factors of CSW among the adults with ASD. However, significant
correlations were found for “enthusiastic activity” (r = .48, p < .01) and “prosocial behavior” (r = .33, p<.05) in the control group.
Spearman’s rank correlation coefficients were also calculated for the sub-factors of CSSW andsubjective well-being for the adults with ASD and the control group (Table 4). Significant
correlations were found for “athletic competence” (r = .46, p < .05) and “friendships” (r = .49, p < .05)
in CSSW among the adults with ASD. Meanwhile, significant correlations were found for“enthusiastic activity” (r = .48, p < .01), “friendships” (r = .36, p < .05), and “prosocial behavior” (r = .40,
p < .01) in CSSW for the control group.
Finally, Spearman’s rank correlation coefficients were calculated between the corresponding
sub-factors of CSW and CSSW (Table 5). According to the results, there were significant correlations
for “enthusiastic activity” (r = .70, p < .01) and “friendships” (r = .49, p < .05) among the adults with
ASD. Significant correlations were found in “athletic competence” (r = .74, p < .01), “enthusiastic
activity” (r = .57, p < .01), “friendships” (r = .52, p < .01), and “prosocial behavior” (r = .73, p < .01) inthe control group.
3.3

Distribution of the scores for CSW, CSSW, and subjective well-being
Figure 1 presents scatter plots for the sub-factors of CSW and subjective well-being for the
adults with ASD and the control group. Specifically, the scores for “enthusiastic activity” in CSW
ranged from 3 to 6 for the adults with ASD, whereas those for the control group ranged from 1 to 6.
The scatter plots of the sub-factors of CSSW and subjective well-being for the adults with ASD
and the control group are shown in Figure 2. For “athletic competence” in CSSW, the scores ranged
from 1 to 3 for the adults with ASD, whereas the scores ranged from 1 to 5 for the control group.

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Journal of Developmental Disabilities Research No. 1
4

3

2

1

4

4

3

3

2

2

1

1

4

3

2

1

Figure 1

Scatter plots for the sub-factors of contingencies of self-worth and subjective well-being●Adults with ASD ×Control group

4.

Discussion

In order to clarify the relationship between CSW, CSSW, and subjective well-being of the adults
with ASD, we first examined the relationship between CSW and CSSW (Table 5). Next, we focusedon the relationship between subjective well-being and CSSW, by comparing the adults with ASD
and the control group. Moreover, we examined the relationship between subjective well-being and
CSSW in more detail by focusing on CSW.
4.1

Relationship between CSW and CSSW
Upon examining the correlations between the factors in the CSW Scale and the CSSW Scale,there were significant correlations between “enthusiastic activity” and “friendships” in the adults
with ASD. However, no significant correlations were found for “athletic competence,” “prosocial
behavior,” and “appearance” among them. In the control group, except for “appearance,” there were─ 44 ─

Journal of Developmental Disabilities Research No. 1
4

4

3

3

2

2

1

1

4

4

3

3

2

2

1

1

4

3

2

1

Figure 2

Scatter Plots for the sub-factors of contentment of sources of self-worth and subjective well-being●Adults with ASD ×Control group

significant correlations between CSW and CSSW for “athletic competence,” “enthusiastic activity,”“friendships,” and “prosocial behavior.”
Given that CSW are related to motivation (Ohtani, 2012), it is thought that people are motivatedtoward objects with high CSW. Thus, CSSW toward objects with high CSW may be higher. In thisregard, Ito et al. (2013) found that the correlation coefficients of the sub-factors of CSW and CSSW
ranged from .20 to .57, showing a weak to moderately significant correlation. In the present study,
moderately significant correlations were found between CSW and CSSW for “enthusiastic activity”
and “friendships” among adults with ASD, which is similar to the findings of previous research (Ito etal., 2013).
Conversely, the reason why almost no correlation was found for “athletic competence” and“appearance” in the sub-factors of CSW and CSSW among the adults with ASD may be due to thedifficulty of increasing CSSW for “athletic competence” and “appearance.” Even if some people with
ASD have high “athletic competence” in CSW, and although they engage in physical activity, it may─ 45 ─

Journal of Developmental Disabilities Research No. 1

not necessarily increase “athletic competence.” In particular, adults with ASD have been noted tohave physical clumsiness. For example, in their meta-analysis, Kimberly et al. (2010) noted that
impaired coordinated movement is a characteristic of ASD. The difficulty of individuals with ASD in
exercising may be one of the reasons for no correlation between the corresponding factor “athleticcompetence” of CSW and CSSW. Similarly, it may be that even if adults with ASD attempt toimprove their appearance when CSW is high, it does not necessarily lead to an increase in their“appearance.” This may be the reason why no correlation was found in “appearance” between the
sub-factors of CSW and CSSW.
4.2

The relationship between CSW, CSSW, and subjective well-being: A comparison of high andlow
4.2.1 Athletic competence
The results of the correlation analysis showed that there is almost no relationship between“athletic competence” in CSW and subjective well-being among the adults with ASD. However, thehigher the “athletic competence” in CSSW is, the higher subjective well-being is. In the control
group, there was almost no relationship between CSW and CSSW in “athletic competence” andsubjective well-being. In terms of “athletic competence” in the CSSW Scale, the better the adults
with ASD were at sports/athletics, the higher their subjective well-being.
Benson et al. (2019) compared the time spent on physical activities among 15 adults with ASD,
whose mean age was 22.8 years. Based on their findings, the adults with ASD spent less time on
medium- and high-intensity physical activities. These results suggest that adults with ASD tend to
spend less than half as much time on medium- and high-intensity physical activities, compared totypically developing adults, and that such exercise may enhance their subjective well-being. Hamm
and Yun (2018) also investigated the relationship between physical activities and self-determination
theory among 143 adults with ASD, whose mean age was 25 years. As for self-determination theory,humans have three basic psychological needs: 1) the need for competence; 2) the need for autonomy;
and 3) the need for relatedness (Ito, 2021). The results revealed that the higher the satisfaction of
three basic psychological needs in humans, the higher motivation for physical activity in adults with
ASD was (Hamm and Yun, 2018). Hence, when considering support for adults with ASD, it isimportant to make decisions according to these three aspects.
Furthermore, as individuals with ASD have been reported to have difficulties with exercise(Watahiki et al, 2020), some may not necessarily be motivated to exercise. Therefore, while providing
support to individuals with ASD in exercise, it may be necessary to consider their motivation forexercise and ensure that they are not compelled to exercise against their will.
4.2.2 Enthusiastic activity
Based on the results of the Mann-Whitney U test, the adults with ASD had higher “enthusiastic
activity” in terms of CSW and CSSW, compared to the control group. In terms of this sub-factor in
the CSW Scale, adults with ASD stated that it was important for them to be enthusiastic about theirinterests and felt confident when they engaged in something they liked. Such beliefs were higher
than those of the control group.
The results of the correlation analysis also showed that there was a minimal relationshipbetween “enthusiastic activity” and subjective well-being in CSW among the adults with ASD. On
the other hand, in the control group, the higher “enthusiastic activity” of CSW was, the higher
subjective well-being was. Moreover, the higher “enthusiastic activity” of CSSW was, the higher
subjective well-being was.
─ 46 ─

Journal of Developmental Disabilities Research No. 1

Kojima (2020) interviewed a sample of individuals with ASD, whose mean age was 19.8 years,
and asked about the source of their subjective well-being. According to the findings, hobbies were
the source. In a related study, Grove et al. (2018) also investigated the actual situation of special
interests, and the relationship between special interests and a range of quality of life measuresamong 687 adults with ASD, whose mean age was 42.4 years. Note that Grove et al. (2018) define
special interests in the following way: “people on the autism spectrum often have extraordinary
intense or specific interests, this is what we refer to as a special interest in a topic.” Their results
showed that computers and music were relatively common interests for adults with ASD.
Furthermore, adults with ASD with specific interests had higher life satisfaction of leisure activities
than those without such interests. However, although the effect sizes were not large, it was foundthat the more time spent in specific interests, the lower subjective well-being.
Furthermore, Grove et al. (2018) investigated the relationship between special interest motivationand subjective well-being of individuals with ASD with an average age of 42.4 years. Results
revealed that there was motivation for special interest that led to the subjective well-being ofindividuals with ASD as well as motivation for special interest that did not lead to the subjective
well-being. The higher the two factors of “personal life values and goals” and “engagement and flow,”
the higher the subjective well-being of participants with ASD tended to be.
The “personal life values and goals” factor included statements such as “I chose this special
interest because it allows me to reach my life goals” and “because it is a good way to learn lots ofthings that could be useful in other areas of my life” (Grove et al., 2016). The “engagement and flow”
factor was “for the sense of sheer enjoyment I experience doing my special interest,” “because I likethe feeling of being totally immersed in my special interest,” etc. (Grove et al., 2016).
In light of the above, one possible background factor for the lack of a significant relationshipbetween subjective well-being and “enthusiastic activity” in CSSW for individuals with ASD may be
the presence of motivation to engage in things that are interesting to them. It is possible that“personal life values and goals” and “engagement and flow” were not very high in motivating
individuals with ASD, who are targeted in this study to engage in activities that they are interested
in. When providing support for the “enthusiastic activity” in CSSW for individuals with ASD, it may
be effective to provide support based on the motivations of the particular interests of individuals
with ASD.
4.2.3 Friendships
Based on the results of the Mann-Whitney U test, “friendships” were higher among the adults
with ASD, compared to the control group. Based on “friendships” in the CSW Scale, the adults with
ASD believed that having a trusted friend is important and that they felt more confident inthemselves by having a friend they could talk to about anything, compared to the control group. In
addition, adults with ASD felt that they had trusted friends, compared to the control group.
In related research, Baron-Cohen and Simon (2003) conducted a direct-response questionnaire
survey of the friendships among 68 people with ASD (without intellectual disabilities) and typicallydeveloping people, with a mean age of 34.3 years. Their results showed that the friendships of adults
with ASD were negative than those of typically developing people. The results showed that thefriendships of people with ASD were significantly lower than the control group, which is at variancewith the results of the present study. Although the present study did not identify a clear reason forthis discrepancy, one possible reason is the individual differences in the friendships among the adults
with ASD. Their study also indicated that the higher the autism spectrum index, the worse thefriendships (Baron-Cohen and Simon, 2003), which is, again, possibly due to the individual differences─ 47 ─

Journal of Developmental Disabilities Research No. 1

in such friendships.
The results of the correlation analysis indicated that there is a minimal relationship between“friendships” in CSW and subjective well-being among adults with ASD. However, the greater“friendships” in CSSW are, the higher subjective well-being is. Kojima (2020) interviewed a sample ofpeople with ASD, whose mean age was 19.8 years, and asked about the source of their subjective
well-being. Based on the findings, a number of adults with ASD indicated that the source of theirsubjective well-being was friends. Specifically, responses such as “I feel happy when I am talking to
my friends” were found, supporting the results of this study.
Conversely, some adults with ASD reported a minimal relationship between friends andsubjective well-being. In this regard, Mazurek (2014) investigated the relationship between thenumber and quality of friends and subjective well-being among adults with ASD aged 18 to 62 years(mean age: 32.4 years), and found that there was a minimal relationship between the number andquality of friends and subjective well-being.
Possible reasons for this contradictory result can be discussed in terms of the age in life and theinfluence of the scale. First, regarding the age in life, the ages of the 19 adults with ASD in thisstudy ranged from 20 to 57 years, with a mean age of 27.2 years (SD = 8.2). In Mazurek’s (2014)
study, the adults with ASD ranged in age from 18 to 62 years, with a mean age of 32.4 years (SD =12.5). Since this was not significantly different from our study’s sample, age was not a factor.
As for the influence of the scale used in Mazurek’s (2014) study, i.e., the Unidimensional
Relationship Closeness Scale (Dibble et al., 2011), it measures the degree of intimacy between the self
and a specific attribute such as “friends” or “families.” In this regard, Mazurek (2014) placed “friends”
for the question item in the scale (Dibble et al., 2011) to measure the quality of friends and the degreeof intimacy between friends and the self. There are several questions about how they perceive
friends in various situations in the Unidimensional Relationship Closeness Scale. Conversely, the“friendships” questions in this study were relatively simple and did not specifically ask how one
perceives friends in various situations/settings. Thus, it is possible that the difference in the content
of the question items regarding friends was one of the reasons for the inconsistent result.
®
The PEERS (Program for Education and Enrichment of Relational Skills) is a program that canbe used as a reference for individuals with ASD in enhancing “friendships” in CSSW. PEERS®,
developed at the University of California in Los Angeles, is a program for making friends tailored tothe characteristics of ASD (Tanaka & Yamada, 2020). The PEERS® has already been implemented in
more than 125 countries (Itani et al., 2022), and there have been significant improvements incommunication (Yamada et al., 2020) and increased self-esteem (Schiltz et al., 2018). In other words,
PEERS® may be effective in increasing self-esteem by enhancing the “friendships” of individuals with
ASD in CSSW, and consequently, in increasing their subjective well-being.
4.2.4 Prosocial behavior
According to the results of the correlation analysis, there was no significant difference between“prosocial behavior” and subjective well-being in CSW among the adults with ASD, nor was there asignificant difference between “prosocial behavior” and subjective well-being in CSSW. Feng andZhang (2021) examined 1,106 adults aged 30 to 60 years, with a mean age of 37.06 years. They foundthat “prosocial behavior” had a positive effect on subjective well-being, supporting the results of thecontrol group in the present study. Hence, it can be concluded that the higher “prosocial behavior,”
the higher subjective well-being of the control group.
Regarding the correlation coefficient between “prosocial behavior” and subjective well-being interms of effect size, the coefficient of CSSW was .40 for the control group, while the coefficient was─ 48 ─

Journal of Developmental Disabilities Research No. 1.34 for the adults with ASD. Therefore, there was no major difference in effect size, and that therelationship between “prosocial behavior” in CSSW and subjective well-being of both the adults with
ASD and the control group were generally comparable.
4.2.5 Appearance
The results of the correlational analysis showed that there was a minimal relationship between“appearance” in CSW and CSSW and subjective well-being, for adults with ASD. These aspects weresimilar to those of the control group. Diener et al. (1995) examined the relationship between
subjective physical attractiveness and subjective well-being among 221 college students and found asignificant weak correlation of .29. In the present study, the correlation coefficient between“appearance” and subjective well-being in CSSW for the adults with ASD was not significant, but
remained weak at .36. This suggests that this relationship was generally comparable to that of thecontrol group.

5.

Limitation and future research recommendations

One limitation of this study is that the adults with ASD were those whose parents/guardians
belonged to parent associations for children and youth with developmental disabilities. It is assumed
that such parents are more motivated to obtain information on childrearing. Therefore, it is possiblethat many of the adults with ASD were more likely to receive the necessary social support, thus
having fewer challenges in everyday life.
Note

＊1

 lthough Ito et al. (2011). used the term “contentment of sources of self-esteem,” we usedA
the term “contentment of sources of self-worth” to correspond with the term “contingencies
of self-worth,” which is commonly used as an academic term in Japan and abroad.
Additionally, the term “self-worth” is used synonymously with the definition of “self-esteem”(Endo, 2013).

Acknowledgments
I would like to express my deepest gratitude to people for their cooperation in this survey.
Funding
This study was supported by the Grant-in-Aid for the Japan Society for the Promotion of
Science Fellows (JP22J10309).

References
Baron-Cohen, S. & Wheelwright, S. (2003). The friendships questionnaire: An investigation of adults withAsperger syndrome or high-functioning autism, and normal sex differences. Journal of Autism andDevelopmental Disorders, 33, 509–517.
Baumeister, R. F., Campbell, J. D., Krueger, J. I. & Vohs, K. D. (2003). Does high self-esteem cause better
performance, interpersonal success, happiness, or healthier lifestyles? Psychological Science in the Public
Interest, 4, 1-44.
Benson, S., Bender, A. M., Wickenheiser, W., Naylor, A., Clarke, M., Samuels, C. H. & Werthner, P. (2019).
Differences in sleep patterns, sleepiness, and physical activity levels between young adults with autism
─ 49 ─

Journal of Developmental Disabilities Research No. 1

spectrum disorder and typically developing controls. Developmental Neurorehabilitation, 22, 166-173.
Crocker, J., Sommers, S. R. & Luhtanen, R. K. (2002). Hopes dashed and dreams fulfilled: Contingencies of selfworth and graduate school admissions. Personality and Social Psychology Bulletin, 28, 1275–1286.
Crocker, J., Luhtanen, R. K., Cooper, M. L. & Bouvrette, A. (2003). Contingencies of self-worth in college
students: Theory and measurement. Personality Social Psychology, 85, 894-908.
Dibble, L., Levine, T. & Park, H. S. (2011). The Unidimensional Relationship Closeness Scale (URCS): Reliability
and validity evidence for a new measure of relationship closeness. Psychological Assessment, 24, 565-72.
Diener, E., Wolsic, B. & Fujita, F. (1995). Physical attractiveness and subjective well-being. Journal of
Personality and Social Psychology, 69, 120–129.
Diener, E., Suh, E. M., Lucas, R. E. & Smith, H. L. (1999). Subjective well-being: Three decades of progress.
Psychological Bulletin, 125, 276-302.
Endo, Y. (2013). Self-esteem. In T. Fujinaga (Ed.), Saishin shinrigaku ziten: [New encyclopedia of psychology](pp. 287-290). Tokyo: Heibonsha. (in Japanese)Feng, L. & Zhang, L. (2021). Prosocial tendencies and subjective well-being: The mediating role of basic
psychological needs satisfaction. Social Behavior and Personality, 49. 1-10.
Gilman, R. & Huebner, E. S. (2006). Characteristics of adolescents who report very high life satisfaction.
Journal of Youth and Adolescence, 35, 293-301.
Grove, R., Roth, I. & Hoekstra, R. A. (2016). The motivation for special interests in individuals with autism andcontrols: Development and validation of the special interest motivation scale. Autism Research, 9, 677-688.
Groove, R., Hoekstra, R. A., Wierda, M. & Begeer, S. (2018). Special interests and subjective wellbeing in
autistic adults. Autism Research, 11, 766-775.
Hamm, J. & Yun, J. (2018). The motivational process for physical activity in young adults with autism
spectrum disorder. Disability and Health Journal, 11, 644-649.
Itani, T., Nishimaki, Y. & Kuroda, H. (2022). A program to support friendships for adolescents with autism
spectrum disorder: A practical report on the online version of PEERS. Annual report of the Institute ofCounseling, Taisho University, 45, 5-14. (in Japanese)
Ito, Y., Sagara, J., Ikeda, M. & Kawaura, Y. (2003). Reliability and validity of subjective well-being Scale. The
Japanese Journal of Psychology, 74, 276-281. (in Japanese)
Ito, M. & Kodama, M. (2005). Sense of authenticity, self-esteem, and subjective and psychological well-being.
The Japanese Journal of Educational Psychology, 53, 74-85. (in Japanese)
Ito, M., Kawasaki, N. & Kodama, M. (2011). Three types of self-esteem: Its characteristic differences ofcontingency and contentment of sources of self-esteem. The Japanese Journal of Psychology, 81, 560–568. (inJapanese)Ito, M., Kawasaki, N. & Kodama, M. (2013). Sources of self-esteem among Japanese university students fromthe perspectives of contingency and contentment. The Japanese Journal of Health Psychology, 26, 73-82. (inJapanese)Ito, T. (2021). Self-determination theory. In Koyasu M., Tanno, Y. & Hakoda Y. (eds.), Yuhikaku dictionary ofpsychology (p. 297), Tokyo: Yuhikaku Publishing. (in Japanese)
Kikuchi, T. (2010). Developmental progress: Identify the developmental stage. In Beppu S. & Kojima M. (eds.),
Understanding high-functioning autism: Enhancing self-esteem (pp. 25-51). Tokyo: Yuhikaku Publishing. (inJapanese)
Kimberly, A. F., Chris, J. H., Sagar, K. N., Neha, L. & James, H. C. (2010). Motor coordination in autism
spectrum disorders: A synthesis and meta-analysis. Journal of Autism and Developmental Disorders, 40,
1227-1240.
Kojima, M. & Noutomi, K. (2013). Self-esteem, self-evaluation, and social-support for children with high─ 50 ─

Journal of Developmental Disabilities Research No. 1

functional pervasive developmental disabilities in forth to sixth grade of elementary school. Japanese
Journal of Learning Disabilities, 22, 324-334. (in Japanese)
Kojima, M. (2018). Self-Esteem and subjective well-being of people with autism spectrum disorder. Japanese
Journal of Learning Disabilities, 27, 491-499. (in Japanese)
Kojima, M. (2020). Subjective well-being of people with ASD in Japan. Advances in Autism, 6, 129-138.
Maras, K. L. & Bowler, D, M. (2012). Brief report: Suggestibility, compliance and psychological traits in highfunctioning adults with autism spectrum disorder. Research in Autism Spectrum Disorders, 6, 1168-1175.
Mazurek, M.O. (2014). Loneliness, friendships, and well-being in adults with autism spectrum disorders.
Autism, 18, 223-232.
Nguyen, W., Ownsworth, T. Nicol, C. & Zimmerman, D. (2020) How I see and feel about myself: Domainspecific self-concept and self-esteem in autistic adults. Frontiers in Psychology, 11, 1-12.
Ohtani, K. & Nakaya, M. (2010). Development of the Contingencies of Self-Worth Scale for Japanese youngadolescents. The Japanese Journal of Personality, 18, 233-236. (in Japanese)
Ohtani, K. (2012). The joint influence of academic contingency of self-worth and perceived cumulative
achievement on academic motivation. The Japanese Journal of Personality, 21, 190–193. (in Japanese)
Scheeren, A. M., Buil, J. M., Howlin, P., Bartels, M. & Begeer, S. (2022). Objective and subjective psychosocial
outcomes in adults with autism spectrum disorder: A 6-year longitudinal study. Autism, 26, 243-255.
Schiltz, H. K., McVey, A. J., Dolan, B. K., Willar, K. S., Pleiss, S., Karst, J. S., Carson, A. M., Caiozzo, C., Vogt, E.
M., Yund, B. D. & Hecke, A. V. V. (2018). Changes in depressive symptoms among adolescents with ASD
completing the PEERS® social skills intervention. Journal of Autism and Developmental Disorders, 48, 834843.
Sell, J. & Nagpal, R. (1992). Assessment of subjective well-being, the subjective well-being inventory (SUBI).
New Delhi: Regional office for South-East Asia, World Health Organization. https://apps.who.int/iris/handle/10665/204813 (accessed 2022-10-21)
Uchida, Y. (2008). Contingencies of self-worth in Japanese culture: Validation of the Japanese Contingencies of
Self-Worth Scale. The Japanese Journal of Psychology, 79, 250-256. (in Japanese)
Watahiki, K., Sawae, Y., Shimada, H. & Nakai, A. (2020). Clinical features and intervention effects of a throwing
task for clumsy children with autism spectrum disorder: Focusing on differences in qualitative change ofthrowing motions. The Japanese Journal of Autistic Spectrum, 17, 59-67. (in Japanese)
Yamada, T., Miura, Y., Oi, M., Akatsuka, N., Tanaka, K., Tsukidate, N., Yamamoto, T., Okuno, H., Nakanishi, M.,
Taniike, M., Mohri, I. & Laugeson, E. A. (2020). Examining the treatment efficacy of PEERS in Japan:
Improving social skills among adolescents with autism spectrum disorder. Journal of Autism andDevelopmental Disorders, 50, 976–997.
Tanaka, S. & Yamada, T. (2020). Tomodachizukuri no kagaku: “PEERS® puroguramu” no zissen: [The scienceof making friends: PEERS® Program in action]. The Journal of Child & Brain Development, 11, 62-70. (inJapanese)─ 51 ─

［Paper］

The “Sense of Difficulty” Related to Developmental Disorders inJapanese High School Students: A Case Study of a Yogo Teacher’s
Experience
Kotaro Kusaka

Faculty of Letters, Meiji Gakuin University

Soichi HashimotoSupport Center for Special Needs Education and Clinical Practice on Education, Tokyo Gakugei University

Toshiaki Taketatsu

Doctral Course United Graduate School of Education, Tokyo Gakugei University

Aki Doyama

Faculty of Human Sciences, Mejiro University

Abstract
This study examines the relationship between the severity of developmental disorder-relateddifficulties (sense of difficulty: SOD) of students who use the health room, the seriousness of theirproblems, and their need for assistance. Five hundred Yogo teachers working at high schools in theTokyo metropolitan area are surveyed. They are asked to name one student with high support
needs and one with low support needs among the students they teach and to rate these students ona checklist of developmental disorder-related difficulties. Factor and cluster analyses are conducted
to examine the relationship between the clusters obtained and the level of the students’ support
needs. The means and standard deviations of each item on the checklist are calculated for eachcluster, and each support needs level. The analysis results suggest that many students who use thehealth room had difficulties related to developmental disorders and that the greater the difficulties,
the more likely they are to develop serious problems. We found that the greater the sense ofdifficulty for both ASD and ADHD disorders, the greater the risk factor for more serious problems.
We suggest it is necessary to respond to students who visit the health room with mental healthproblems from the perspective of “developmental disorder SOD,” regardless of whether they have adiagnosis.
Keywords: Sense of difficulty, developmental disorders, Japanese high schools, Yogo teacher, School
adaptation

1.

Introduction

According to the Basic School Survey for FY2020 (MEXT, 2021), Japan’s high school enrollment
rate is over 98.8%. Non-attendance and school maladjustment among high school students remain
serious problems. It has been reported that “apathy/anxiety” was the most common reason for nonattendance, at 36.8%, followed by “disruption of daily rhythm, play, and delinquency” (12.4%),“problems surrounding friendships except bullying” (10.5%), and “maladjustment upon entering or─ 52 ─

Journal of Developmental Disabilities Research No. 1

transferring to school or promotion” (10.5%) (MEXT, 2022). Although the number of high school
dropouts has decreased over the past ten years, it has remained at the high level of 39,000 (about
1.2% of the total), which is still not ideal. Psychological factors, such as stress and emotional control,
are believed to aggravate these problems (Okada, 2002). Therefore, capturing and examining thepsychological aspects of students will help in responding to these problems. It has been pointed outthat people with developmental disorders often face various stresses due to their characteristics andare prone to maladjustment to the environment because they do not have appropriate methods ofaccepting and coping with stress (Hayashi et al., 2015). Yamashita (2015) also stated the necessity of
examining the possibility that developmental disorders, such as autism spectrum disorder (ASD) andattention deficit hyperactivity disorder (ADHD), exist behind mental health problems in children.
Furthermore, high school is a time when students experience major changes, both mentally andphysically. It has been pointed out that students with developmental disorders, especially during thisperiod, may become emotionally unstable with low self-esteem, which may develop into secondary
disorders such as truancy, school maladjustment, and problematic behaviors (MEXT, 2010). However,a survey conducted in high schools in the Tokyo metropolitan area reported that 24.6% of thestudents had mild developmental disorders, and the number of students requiring special support
education has been increasing annually (Tobe et al., 2013). Furthermore, the results of a recent largescale epidemiological study (Kamio et al., 2012) on a population of elementary and junior high school
students in Japan revealed that many children do not have a diagnosis of ASD but have many
autistic behavioral characteristics at the subthreshold level. Moriwaki and Kamio (2013) reported
significant emotional and conduct problems in approximately 10% to 20% of children with many
subthreshold autistic behavioral characteristics. Considering this situation, there is an even greaterneed for an attitude of support that captures the “Komarikan (sense of difficulty; SOD)” that students
with developmental disorders tend to have, regardless of whether they have a diagnosis. Sato (2007)
describes “Komarikan” as “the feeling that a person has when they have a bad or painful experiencebut is unable to solve it on their own and does not know what to do. This is the feeling that a person
has when he or she is in such a state of distress.” In addition, he also stated that “there are cases inwhich the individual does not feel a sense of distress, even though they are in such a state. Thereare cases in which it is fully expected that the individual will fall into such a state in the future, even
if no problem arises at present. Still, from the perspective of providing educational support to theindividual, it is desirable to judge that a ‘Komarikan’ exists in these cases as well.” (Sato, 2007).
Takahashi (2012) pointed out that, in supporting university students with developmental disorders, it
is easier to provide support by assessing the “Komarikan” caused by the characteristics of thedevelopmental disorders rather than by identifying the characteristics of the students’ developmental
disorders. Furthermore, he proposed support methods that focus on university student’s “Komarikan”
by developing the “ASD Komarikan Questionnaire” (Yamamoto and Takahashi, 2009), “ADHD
Komarikan Questionnaire” (Iwabuchi and Takahashi, 2011), and “Integrated Komarikan
Questionnaire” (Takahashi, 2012). However, in Japan, there are almost no studies investigating thedifficulty high school students with developmental disorders such as ASD and ADHD tend to feel.
This study defines this feeling as “developmental disorder SOD” or “SOD.”
A health room is where students with such mental health problems can be identified. In Japan,
health room are staffed by a faculty member called a Yogo teacher. A “Yogo teacher” is a special
licenced educator who supports children’s growth and development through health education andhealth services on the basis of principles of health promotion in all areas of educational activities inschool (Japanese Association of Yogo Teacher Education, 2003). Yogo teachers accurately grasp the─ 53 ─

Journal of Developmental Disabilities Research No. 1

condition of students’ health needs and environmental health and guide students with mental andphysical health problems (MEXT, 2015). Therefore, it is important to make efforts for early detection
and responses to these problems through health consultations (MEXT, 2017). According to the reporton the survey of the status of health room use in 2016 (Japan School Health Association, 2018), themost common background factor for students who used the health room in high schools was “mainly
psychological problems” at 41.6%. The percentage of Yogo teachers who experienced continuous
support within approximately one year was 91.4%. A survey conducted on Yogo teachers in highschools also pointed out that many Yogo teachers deal with students who complain of mental andbehavioral disorders (Nakano et al., 2018). Hence, there may be many students with developmental
problems among those involved with Yogo teachers in the health room.
Therefore, this study aims to provide information to support high school students with mental
health problems in Japan from the viewpoint of “developmental disorder SOD” by examining therelationship between the severity of the students’ problems and their need for support (“support
needs”). This study aims to provide materials for supporting high school students with mental healthproblems in Japan from the viewpoint of “developmental disorder SOD.”

2.

Method

2.1

Survey targets and methods
A questionnaire survey was conducted on 500 Yogo teachers enrolled in national, public, andprivate high schools in the Metropolitan area (Tokyo, Saitama Pref., Chiba Pref., Kanagawa Pref.,Yamanashi Pref., and Gunma Pref.). The 1161 targeted schools were divided into three categories: coeducational schools, boys’ schools, and girls’ schools, and each school was numbered. Thereafter, a
simple random sampling was conducted using a random number table, and 500 schools wereselected. The following questionnaire was mailed to the selected 500 schools; the teachers were asked
to answer the questionnaire and return it directly. The 204 respondents were included in theanalysis (response rate: 40.8%). The survey period was from July to August 2019.
The purpose and procedure of the survey were explained in writing to school principals andYogo teachers (respondents); ethical considerations were explained in writing, such as the freedom to
respond, the fact that responses obtained would be statistically processed, that anonymity would beensured when the results were published, and that consent was obtained by responding. In addition,from the viewpoint of privacy protection, the respondents were asked to provide sufficientconsideration to individual cases so they would not be identified. This study was approved by the
Research Ethics Committee of the Institution to which the first author belongs.
2.2

Investigation details
The questionnaire items consisted of three parts: (1) a face sheet, (2) a questionnaire about the
SOD of students who use the health room and have high support needs, and (3) a questionnaire
about the SOD of students who use the health room and have low support needs.
2.2.1 Face sheet
The subjects were asked to indicate the location of the school where they worked and theiryears of teaching experience.
2.2.2 Mental health of students with high support needs“Please think of one of the students you were involved with in the health room who had been
‘excessively absent or tardy, expelled or retained from school, or punished for student guidance─ 54 ─

Journal of Developmental Disabilities Research No. 1

problems’ and whose background was thought to contain psychological factors such as stress.”
Thereafter, they were asked how much the student had trouble with each item on the checklist.
These were evaluated on a 5-point scale: 1, not troubled at all; 2, not very troubled; 3, undecided; 4,
troubled; and 5, very troubled. This checklist consists of 12 items, 6 from the “ASD Komarikan
Questionnaire” (Yamamoto et al., 2009) and 6 from the “ADHD Komarikan Questionnaire” (Iwabuchi
et al., 2011), with some modifications. This checklist was designed for university students, but since asimilar checklist for high school students does not exist, the authors decided to use some of the items
from this checklist with changes in wording that they believe are applicable to high school students
in this study. The authors also gave each item an “Item Names” that they considered appropriate.
2.2.3 Mental health of pupils with low support needs
The students were asked to complete the same checklist as in 2.2.2, “Please think of one student
whom you have been involved with in the health room who does not fall into the category 2.2.2, andabout whom you are particularly concerned, such as frequent use of the health room.” Thereafter,
they were asked about the degree to which the student had trouble with each item on the checklist,
as in 2.2.2.
2.3

Analysis method
The responses to the face sheet were tabulated. Next, factor and cluster analyses wereconducted on the responses to checklists 2.2.2 and 2.2.3, and the relationship between the obtained
clusters and the level of support needs was examined. The mean and standard deviation of each itemin the checklist were calculated for each cluster. The above analyses were conducted on the scoresof 373 students (182 students with high support needs and 191 students with low support needs)
whose answers were not incomplete, such as through missing values.

3.

Results

Of the 204 schools that responded, 63 (30.9%) were in Tokyo, 36 (17. 7%) in Saitama Pref., 57(27.9%) in Chiba Pref., 22 (10.8%) in Kanagawa Pref., 10 (4.9%) in Yamanashi Pref., and 16 (7.8%) in
Gunma Pref.. The average teaching experience of respondents was 18.2 years (SD = 11.7).
3.1

Factor structure of the checklist
An exploratory factor analysis (maximum likelihood method, Promax rotation) was conducted on
the 12 items of the SOD checklist based on the scores of 373 subjects included in the analysis. The
number of factors was set to two by considering the decay pattern of eigenvalues (3.260, 2.058, 0.993,
etc.) and the interpretability of the factors. However, two items had factor loadings of less than.35, sothese items were excluded, and factor analysis was conducted again. The final factor pattern after
rotation is shown in Table 1. Factor 1 was named the “ASD SOD factor” because high loadings were
found for items related to ASD, such as “making friends,” “conversation,” “group,” “isolation,” and“others’ viewpoints.” Factor 2 was named the “ADHD SOD factor” because it loaded highly on items
related to ADHD, such as “inattention,” “multiple tasks,” “impulsivity,” “life rhythm,” and “emotional
control.” To examine internal consistency, alpha coefficients were calculated for each factor, withalpha = .851 for the “ASD SOD” factor and alpha = .650 for the “ADHD SOD” factor. The correlation
between the factors was .1 25. The average scores of the items included in each factor were definedas the “ASD SOD score” and the “ADHD SOD score,” and the sum of the “ASD SOD score” and“ADHD SOD score” was defined as the “Developmental disorder SOD score.”─ 55 ─

Journal of Developmental Disabilities Research No. 1

Table 1Results of the factor analysis for the SOD checklist

3.2

Classification by SOD
Using the “ASD SOD score” and “ADHD SOD score,” we conducted cluster analysis using theWard method to obtain four clusters (Figure 1). The first included 101 subjects, the second included
111 subjects, the third included 56 subjects, and the fourth included 105 subjects.
Next, one-factor analysis of variance was conducted using the four clusters as independent
variables and the “ASD SOD score” and “ADHD DOD score” as dependent variables. The results
showed that there were significant differences between the clusters (ASD SOD score: F (3, 369) =252.42, ADHD SOD score: F (3, 369) = 227.00, both p < .001), and multiple comparisons using Holm’s
method (1% level) revealed that the “ASD SOD score” was significantly higher in the first and third
clusters than in the second and fourth clusters. There was also a significant difference in the “ADHD
SOD score,” with the result of the third cluster > second cluster > first cluster > fourth cluster. The
first cluster was designated as the “ASD SOD group” because its “ASD SOD score” was high and its“ADHD SOD score” was low. The second cluster was defined as the “ADHD SOD group” because
the “ADHD SOD score” was high and the “ASD SOD score” was low. The third cluster was definedas the “ASD & ADHD SOD group” because both “ASD SOD scores” and “ADHD SOD scores” tended

Figure 1

Standardized scores for SOD for each cluster─ 56 ─

Journal of Developmental Disabilities Research No. 1

to be high. The fourth cluster was defined as the “non-ASD & ADHD SOD group” because both
“ASD SOD scores” and “ADHD SOD scores” tended to be low (Table 2).
3.3

Relationship with the level of support needs
To examine the relationship between the degree of support needs and developmental disorder
SOD, an uncorrelated t-test was conducted with the degree of support needs as the independent
variable and developmental disorder SOD score as the dependent variable. The results showed asignificant difference between conditions (t (371) = 5.43, p < .001), indicating that students with highsupport needs had higher developmental disorder SOD scores.
Next, to examine the relationship between the level of support needs and each cluster, each of
the four clusters were divided into eight groups (high and low support needs groups), and a chisquare test was conducted on the number of people in each group; a significant relationship was
found (χ2 (3, N = 373) = 16.40, p < .001) The results of the chi-square test showed a significant
association (Table 1). The number of students with high support needs in the “ASD & ADHD SOD
group” was significantly higher, and the number of students with low support needs in the “non-ASD& ADHD SOD group” was significantly higher (Table 3).
Finally, each group’s mean and standard deviation were calculated for each of the items in the
checklist (Table 4).

4.

Discussion

The factor analysis results for the SOD checklist showed that the checklist had a two-factor
structure, namely the “ASD SOD factor” and “ADHD SOD factor,” as shown in Table 1. Thisconfirmed the validity of the checklist in capturing the sense of the difficulty of students with ASD
and ADHD. However, the value of the alpha coefficient for the ADHD SOD factor was rather low at
0.650. Further refinement is needed in the future.
Cluster analysis was conducted based on these scores, and the results were divided into fourclusters: “ASD SOD group,” “ADHD SOD group,” “ASD & ADHD SOD group,” and “Non-ASD &ADHD SOD group,” as shown in Figure 1. DSM-5 (American Psychiatric Association, 2013) allows
for the simultaneous diagnosis of ASD and ADHD; it is possible that some of the students in the“ASD & ADHD SOD group” have both ASD and ADHD. On the other hand, the “Non-ASD &ADHD SOD group” had low scores in both the “ASD SOD score” and “ADHD SOD score,”suggesting that they include students who have mental health problems without developmental
Table 2

Table 3

Mean scores for each group

Number of people belonging to each group─ 57 ─

Journal of Developmental Disabilities Research No. 1

Table 4

Mean and standard deviation for each item in the checklist

disorders in their background.
It was also suggested that students with high support needs had more difficulties with
developmental disorders. This study defined these students as “students who were disciplined forexcessive absences and tardiness, expulsion, retention, and student guidance problems, and whosebackground was thought to be one of stress or other psychological factors.” The results suggest thatthe high level of SOD that was unique to students with developmental disorders, such as ASD and
ADHD, may be one of the risk factors for developing such serious problems. However, according to
the report of the 2016 survey on the use of the health room (Japan School Health Association, 2018),
only 5.4% of Yogo teachers cited developmental disorders as a background factor for high school
students who used the health room. This indicates that high school Yogo teacher teachers do notplace as much importance on the perspective of “developmental disorder” as they do on other factors.
Considering the results of this study, we believe that supporting students with the perspective of“developmental disorder SOD” as the background of the problems they face may help to prevent the
problems from becoming more serious. Furthermore, as shown in Table 3, there were many students
with high support needs in the “ASD & ADHD SOD group” whose ASD SOD score and ADHD SOD
score were both high, and many students with low support needs in the “Non-ASD & ADHD SOD
group” where both scores were low. However, there was no bias in the number of students in the“ASD SOD group” and “ADHD SOD group.” Based on these results, it can be inferred that students
with both ASD and ADHD SOD tended to be more likely to develop serious problems, such as school
maladjustment (truancy, dropouts, etc.) and student guidance disciplinary actions.
The mean scores of each item in the checklist for each group in Table 4 suggest that students
in the group with high ASD SOD scores may feel uncomfortable in group activities and isolated in
the group. In recent years, improving classes by actively incorporating group activities has beenpromoted to realize independent, interactive, and deep learning in high schools. This trend may havea considerable influence on their adaptation to school life. This issue needs to be discussed in detailin the future. In addition, it was suggested that many students in the “ADHD SOD group” had high“life rhythm” scores. In addition, there was a large difference in the “life rhythm” scores of the “nonASD & ADHD SOD group.” High school students are at an age when they are more likely to develop─ 58 ─

Journal of Developmental Disabilities Research No. 1

autonomic nervous system problems and sleep disorders (Kametaka et al., 2000; Ikeda et al., 2015); it
has been pointed out that many students who are absent have these problems. Furthermore, it has
been reported that 25%-50% of ADHD is complicated by sleep disorders (Konofal, Lecendreux,
Cortese, 2010); we believe that the results of this study may reflect this reality. In high schools, thenumber of days absent and tardiness are very strictly regulated as requirements for promotion andgraduation; there are many cases in which the disruption of the daily rhythm directly leads totransfer or expulsion from school. It is necessary to examine the student’s situation and develop
support for them at an early stage in cooperation with medical institutions.

5.

Conclusion

As described above, many students with developmental disorder SOD use the health room, and
it is suggested that the greater the SOD, the more likely it is to develop into a serious problem. We
suggest that the students who come to the health room with mental health problems may be able toprevent these problems from becoming more serious if they are treated from the viewpoint of“developmental disorder SOD.” In this way, Yogo teachers will be required to recognize the problem
as soon as possible and provide appropriate support by connecting students to school counselors andmedical institutions in cooperation with teachers and staff.

References
American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders 5th edn,
Arlington. Amer Psychiatric.
Hayashi, T., Egawa, J. & Someya, T. (2015). Sutoresukanrenshogai wo shimesu hattatsu shogai: [Developmental
Disorders Presenting with Stress-Related Disorders]. Sutoresu Kagaku kenkyu: [The journal of Stress
Science Research], 15, 10-15. (in Japanese)
Ikeda, M. & Kanesaka, Y. (2015). Sleep and health from adolescence to early adulthood. Journal of the National
Institute of Public Health. 64, 11-17.
Iwabuchi, M. & Takahashi, T. (2011). Development of support needs questionnaire for students with ADHD.
Annual letters of clinical psychology in Shinshu, 10, 13-24.
Japan School Health Association (2018). Survey Report on the Status of Health Office Usage: Results of theSurvey in Fiscal Year 2016. https://www.gakkohoken.jp/book/ebook/ebook_H290080/index_h5.html#1.
(accessed 2022-12-01).
Japanese Association of Yogo Teacher Education (2003). What is the Yogo teacher ? https://yogokyoyukyoiku-gakkai.jp/?page_id=1520. (accessd 2023-04-01).
Kametaka, K., Gowa, Y., Kitaguchi, K. & Shiraishi, T. (2000). The relationship among orthostatic dysfunction,
lifestyle and unhealthy symptoms in high school students. Memoirs of Osaka Kyoiku University. Ser. 3,
Natural science and applied science. 49, 219-229.
Kamio, Y., Inada, N., Moriwaki, A., Kuroda, M., Koyama, T., Tsujii, H., Kawakubo, Y., Kuwabara, H., Tsuchiya,
K., Uno, Y. & Constantino, J. (2012). Quantitative autistic traits ascertained in a national survey of 22 529
Japanese schoolchildren. Acta Psychiatr Scand. 128, 45-53.
Konofal, E., Lecendreux, M. & Cortese, S. (2010). Sleep and ADHD. Sleep Medicine. 11, 652-6588.
MEXT (2010). Seito shido teiyo: [Student Guidance Guideline]. (in Japanese) https://www.mext.go.jp/a_menu/
shotou/seitoshidou/__icsFiles/afieldfile/2018/04/27/1404008_02.pdf. (accessed 2022-12-01).
MEXT (2015). The School as a Team and Future Improvement Strategies (Report). https://www.mext.go.jp/
─ 59 ─

Journal of Developmental Disabilities Research No. 1

b_menu/shingi/chukyo/chukyo0/toushin/__icsFiles/afieldfile/2016/02/05/1365657_00.pdf. (accessed 202212-01).
MEXT (2017). Enhancement of Educational Counseling for Students (Report) - Creation of an Organized
Educational Counseling System to Enhance the Educational Capability of Schools. http://www.mext.go.jp/
component/b_menu/shingi/toushin/__icsFiles/afieldfile/2017/07/27/1381051_2.pdf. (accessed 2022-12-01).
MEXT (2021). The Current State of High School Education. https://www.mext.go.jp/a_menu/shotou/
kaikaku/20210315-mxt_kouhou02-1.pdf. (accessed 2022-12-01).
MEXT (2022). Results of a Survey on Problematic Behavior, Truancy, and Other Student Guidance Issues.
https://www.mext.go.jp/content/20221021-mxt_jidou02-100002753_1.pdf. (accessed 2022-12-01).
Moriwaki, A. & Kamio, Y. (2013). Associations between Autistic Traits and Psychiatric Issues and Japanese
School Children and Adolescents. The Japanese Journal of Autistic Spectrum. 10, 11-17.
Nakano, S., Hashimoto, S., Miura, T., Kusaka, K., Yamanaka, S. & Lee, S. (2018). Koutogakko・
tokubetsushiengakko koutobu seito no mentaruherusu ni okeru yogokyoyu no yakuwari to tasyokushu
renke: [The Role of Yogo Teachers and Multidisciplinary Cooperation in Mental Health of high School andSpecial Needs School Students]. Hoken no kagaku, Kyorin-shoin. (in Japanese)
Okada, Y. (2002). Psychological Stress in Junior High School Students: A Model for the Occurrence ofSecondary Responses. The Japanese journal of educational psychology, 50, 193-203.
Sato, S. (2007). Jiheisho-ji no komarikan ni yorisou shien: [Support for Autistic Children with a Sense ofDifficulty]. Gakken. (in Japanese)
Takahashi, T. (2012). Hattatsu shogai no aru daigakusei no campus life support book: [Campus Life Support
Book for university Students with Developmental Disabilities]. Gakkenkyoiku-shuppan. (in Japanese)Tobe, T. & Ito, R. (2013). Attitudes toward special needs education of teachers in Tokyo metropolitan highschools. Japanese journal of learning disabilities, 22, 335-342.
Yamamoto, N. & Takahashi, T. (2009). Jiheisho supekutoramu shogai to doyo no koudotokuse wo motsu tokangaerareru daigakuse no shiennizu haku no shitsumonshi no kaihatsu: [Development of a Questionnaire
for Assessing the Support Needs of College Students Considered to Have Behavioral Tendencies Similar toAutism Spectrum Disorders]. Annual letters of clinical psychology in Shinshu, 8, 35-45. (in Japanese)
Yamashita, T. (2015). Mental health of children with autistic spectrum disorder. Japanese journal of
psychosomatic medicine, 55, 1329-1334.

─ 60 ─

［Paper］

Effects of Sub-Threshold Neurodevelopmental Traits on the
Adjustment of Female Students to High School: A Study Focused on
Premenstrual Dysphoric Mood
Takuya Miura

Tokyo University of Agriculture and Technology

Soichi Hashimoto

Tokyo Gakugei University

Abstract
The purpose of this study was to determine the impact of the adjustment to high school on
female students with sub-threshold neurodevelopmental disabilities traits by monitoring
premenstrual discomfort. A questionnaire survey was conducted on a group of 500 high school
seniors and on first- and second-year college students, using the sub-threshold neurodevelopmental
disabilities traits scale, the PMDD rating scale, and the school adjustment questionnaire. To test theaccuracy of each of the scales used, we analyzed them using item response theory. To determine
whether sub-threshold ASD and ADHD traits influenced school adjustment, the analysis was
conducted by monitoring PMDD. The results of this analysis determined that female high school
students with sub-threshold ASD traits have difficulties with school life and study performance. In
the case of female high school students with sub-threshold ADHD traits, PMDD was found tointerfere with school relationships. In particular, female high school students with sub-threshold
ASD traits were more likely than female high school students with sub-threshold ADHD traits toexperience depressed or hopeless moods and to have higher levels of anxiety and tension. These
results suggest that there is an urgent need to develop classroom-based support techniques thatallow for good communication between female high school students with sub-thresholdneurodevelopmental disabilities traits and their peers.
Keywords: Female High School Students, Sub-Threshold Neurodevelopmental Disabilities Traits,
PMDD, School Adjustment

1.

Introduction

In clinical practice, it is often observed that in women symptoms of psychiatric disorders such as
depression, panic disorder, mood dysphoria, and personality disorders, as well as physical disorders
such as asthma, allergic diseases, and epilepsy tend to worsen over time and are poorly controlled
before menstruation (Egawa, 2020). The most severe form of these disorders, in which psychiatric
symptoms are so severe that daily life and interpersonal relationships are severely impaired, is called
premenstrual dysphoric disorder (PMDD). In the Diagnostic and Statistical Manual of Mental
Disorders, Fifth Edition (DSM-5) (American Psychiatric Association, 2013), PMDD is classified as adepressive disorder.
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Journal of Developmental Disabilities Research No. 1

In Japan, the prevalence of moderate to severe PMDD and premenstrual syndrome (PMS)
among female high school students was found to be higher than among adult females (Takeda et al.,2010). A survey of a total of 1,431 female high school students was used to determine the relationshipbetween PMDD and PMS dysmenorrhea, and found that 3.2% of the cases qualified as PMDD. In
addition, the prevalence of PMDD and moderate to severe PMS increased with the severity ofdysmenorrhea, indicating a correlation between PMS and PMDD severity and dysmenorrhea inadolescents (Kitamura et al., 2012). PMDD can interfere with the daily lives of female high school
students and can have serious consequences.
Furthermore, women with intellectual or developmental disabilities are more likely to havemenstrual abnormalities (Yada (Hashimoto) et al. 2017). To determine the prevalence of PMS inwomen with autism, we compared a group of women with autism and learning disabilities (n = 26)
with a group of women without autism and learning disabilities (n = 36). Results showed that a 30%
or greater increase in premenstrual DSM-IV symptoms was an evidence of fulfillment of thediagnostic criteria. The prevalence of PMS was 92% in the autistic group compared to 11% in thecontrol group. This difference was highly significant. Susceptibility to premenstrual syndrome has
been shown to be significantly increased in women with autism (Obaydi and Puri, 2008).
Based on the above previous studies, support for women with developmental disabilities shouldtake into account the impact of women’s unique hormonal fluctuations on their everyday lives (Nodaet al., 2021). In addition, it is assumed that providing appropriate support, especially during theadolescent period of female high school students, will lead to an improvement in mental healthduring adolescence. However, there have been no studies demonstrating an association between subthreshold neurodevelopmental disabilities traits and mood disturbance in PMDD and its impact onschool adjustment among female high school students.
In this study, we clarify the effects of sub-threshold neurodevelopmental disabilities traits on
school adjustment mediated by discomfort in PMDD among female high school students. The
objective of this study is to gain, through the analysis of the results, a perspective on how to bettersupport female students with sub-threshold neurodevelopmental disabilities traits.

2.

Method

2.1

Survey subjects
A total of 500 people were surveyed: 257 high school senior students (120 males and 137 females)and 243 first- and second-year college students (138 males and 105 females).
2.2

Survey timing and means of implementation
The survey was conducted in March 2021. The survey was conducted online through theresearch contractor Rakuten Insight. The parents or guardians of the subjects and the subjects
themselves were asked to consent to the online study in advance, and only the subjects were asked
to complete the questionnaire. The study was approved by the Ethical Review Committee of Tokyo
University of Agriculture and Technology (Approval No. 210203-0270).
2.3 Survey Items
2.3.1 Sub-threshold neurodevelopmental disabilities traits scale
From the questionnaires developed by Takahashi et al. (2015) and Shinoda et al. (2017), seven
items were selected from the sub-threshold Attention-Deficit/Hyperactivity Disorder (ADHD) traits─ 62 ─

Journal of Developmental Disabilities Research No. 1

questionnaire short version and the sub-threshold autism spectrum disorder (ASD) traits
questionnaire, respectively. The representative of the questionnaire creator had confirmed that thequestionnaire could be used by high school students. A five-point scale was used, ranging from “verytroubled (5 points)” to “not troubled at all (1 point)”.
2.3.2 PMDD rating scale
The 12 items of the PMDD Rating Scale developed by Miyoka et al. (2009) were used to evaluate
PMDD, which is defined as symptoms mainly consisting of recurrent mood changes before
menstruation. A five-point scale ranging from “very strongly (5 points)” to “no change (1 point)” wasused.
2.3.3 School adjustment questionnaire
Two items related to poor adjustment to school, “It interfered with my efficiency in school lifeand studies” and “It interfered with my relationships with people at school” (Miyoka et al., 2009),
were selected for female high school students who had one or more symptoms of the PMDD Rating
Scale (all applicable). A five-point scale was used, ranging from “very strongly (5 points)” to nochange maybe “no change? Instead of just NOT (1 point).”
2.4 Method of analysis
2.4.1 Validation of scale accuracy
To verify the accuracy of the scale used in this study, we decided to analyze the results using
Item Response Theory (IRT). The IRT is a method of inferring measurable abilities from the resultsof a questionnaire using responses to items (response status) when the characteristics of the items(difficulty and discrimination) are known. In other words, it is an analytical method that allows
detailed confirmation of measurement accuracy. In addition, since the nature of the population ofsurvey participants does not affect the analysis process, the scale can be used in a variety of school
settings. As shown in (1) to (3) below, the analytical procedure for this study was adapted from
Eguchi (2011) and Uragami and Wakita (2016). Easy Estimation Ver. 2.1.5 by Kumagaya (2009) wasused for the analysis.
(1) Confirmation of unidimensionality of the scale
For each item of the scale used in this study, a factor analysis of the inter-item correlation
matrix using tetrachoric correlation coefficients was performed. The eigenvalues are then plotted ona graph (scree plot) to confirm the unidimensionality of the scale.
(2) Estimation of item parameters
Since the five-item method was used in this study, the Graded Response Model (GRM) was
employed to estimate the item parameters. Then, the discrimination parameter (a) and the difficultyparameter (b) for each item were calculated by the marginal maximum likelihood estimation method.
In this study, the five-case method was used to obtain responses, so four difficulty parameters (b)were estimated for each item (Iwabuchi and Kato, 2018). This analysis yielded an Item Response
Category Characteristic curve (IRCCC) for each item. The IRCCC represents the probability that
respondents with a particular latent characteristic scale value (θ) will select each choice branch. The
position and slope of this curve provide a visual indication of the characteristics of the item inquestion.
The parameter (a), which represents the item’s discriminative power, is an indicator of theextent to which it can identify the respondent’s latent characteristics. A high value implies a highdegree of contribution to the estimation of latent characteristic values (θ). The item difficultyparameter (b) is an index of item difficulty. It represents the position of the item on the latent─ 63 ─

Journal of Developmental Disabilities Research No. 1

characteristics scale. The larger this value is, the more the position of the curve is to the right, andthe smaller it is, the more it is to the left. Therefore, a large value of b expresses that the item
cannot be answered correctly unless the ability value (θ) is high, indicating that it determines thedifficulty of the item. In this study, the level of the discrimination ability parameter (a) was set to a >0.75 (Ironson et al., 1989). The level of the difficulty parameter (b) was set to 4.00 > b > -4.00 (Kijima,
1999).
(3) Estimation of reliability
To examine measurement accuracy, Cronbach’s alpha coefficient was obtained as an estimate of
the reliability coefficient. Generally, when α is 0.7 to 0.8 or higher, it is considered an indication thata certain level of reliability is ensured. The free statistical software HAD by Shimizu (2016) was used
for the analysis.
2.4.2 Characteristics of female high-school students with sub-threshold neurodevelopmental
disabilities traits
The sub-threshold ASD and ADHD traits scores of female high school students were comparedwith those of male high school students and female college students using an unpaired t-test.
2.4.3 Characteristics of PMDD among female high school students
We compared scores for premenstrual unpleasant mood in the group with high scores of subthreshold ASD and ADHD traits using an unpaired t-test with female college students. In addition,
scores are compared between the group with high scores of sub-threshold ASD and ADHD traits
and the group with overlapping sense of distress in female high school students and the group withstereotyped developmental students using a one-way ANOVA.
2.4.4 Effects of characteristics related to sub-threshold neurodevelopmental disabilities traits on
school adjustment among female high school students
A mediation analysis was conducted to see if characteristics of sub-threshold ASD and ADHD
traits influenced school adjustment by mediating PMDD.

3.

Results

3.1

Confirmation of the accuracy of each scale
The accuracy of each scale was confirmed by IRT. First, the inter-item correlation matrix withtetrachoric correlation coefficients was factor analyzed to check its eigenvalues. The first threeeigenvalues were 4.87, 0.60, 0.41, ... for the sub-threshold ASD traits questionnaire; the ratio of thefirst eigenvalue to the second eigenvalue was 4.27, which is large, indicating that theunidimensionality aspect of the scale was satisfied. Next, for the sub-threshold ADHD traits
questionnaire, the scores were 3.99, 0.86, 0.58, ..., and the ratio of the first eigenvalue to the second
eigenvalue is 3.13, which indicated that the unidimensionality of the scale was satisfied. Finally, thePMDD rating scale was 7.81, 0.94, 0.64, ..., and the ratio of the first eigenvalue to the second
eigenvalue was 6.87, which is large, and the unidimensionality of the scale was judged to besatisfying. Next, the GRM was employed in this study to estimate the item parameters by calculating
the discrimination parameter (a) and the difficulty parameter (b) for each item using the marginal
maximum likelihood estimation method. The value of the discrimination parameter (a) was
determined to satisfy the range a > 0.75. The sub-threshold ASD traits questionnaire was 1.97 > a,the sub-threshold ADHD traits questionnaire was 1.42 > a, and the PMDD rating scale was 1.50 > a,meeting the a > 0.75 level of Ironson et al. (1989). The value of the difficulty parameter (b) was
determined to satisfy the range 4.00 > b > -4.00 for all items. The sub-threshold ASD traits
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Journal of Developmental Disabilities Research No. 1

questionnaire was 2.75 > b > -1.56, the sub-threshold ADHD trait questionnaire was 3.26 > b > -1.86,
and the PMDD rating scale was 2.92 > b > -1.15, meeting the Kijima (1999) level of 4.00 > b> -4.00.
Finally, Cronbach’s alpha coefficient was determined for each scale as an estimate of the reliability
coefficient. As a result, a value of α= 0.91 was calculated for the sub-threshold ASD traits
questionnaire, α= 0.84 for the sub-threshold ADHD traits questionnaire, and α= 0.93 for the PMDD
rating scale. The values were determined to be sufficiently internally consistent (Tables 1, 2, and 3).
The English translations of all items of each scale were prepared independently by the authors after
examining their content validity.
3.2

Extraction of female high school students with high scores on each scale
Twenty-three female high school students (16.8% of the female students) had high scores (meanTable 1

Parameter estimates for each model (sub-threshold ASD traits questionnaire)
Location Parameters ＊2 ＊3

Slope
Parameters ＊1

Item

1

2

3

4

a

Standard
ErrorbStandard
ErrorbStandard
ErrorbStandard
ErrorbStandard
Error

1. Past experiences come backto life as if they are happening
in the present, and feelings
become unstable

1. 97

0. 13

-1. 25

0. 08

0. 19

0. 06

1. 52

0. 09

2. 75

0. 19

2. Cannot talk as well as otherpeople

3. 26

0. 19

-1. 03

0. 07

0. 06

0. 04

1. 06

0. 07

2. 25

0. 15

3. Have trouble feeling thatthey are different from theusual person

3. 00

0. 18

-0. 94

0. 06

0. 23

0. 04

1. 43

0. 09

2. 64

0. 20

4. Have trouble feelingcomfortable in group activities

3. 00

0. 18

-1. 06

0. 07

0. 12

0. 04

1. 24

0. 08

2. 46

0. 17

5. Feelings are easily hurt

2. 62

0. 16

-1. 390. 09-0. 09

0. 05

1. 18

0. 07

2. 25

0. 14

6. I am not good at making
new friends when I go toschool or change classes

2. 20

0. 13

-1. 56

0. 10-0. 34

0. 05

0. 80

0. 06

2. 05

0. 12

7. I think other people see me
as being out of place all the
time

2. 76

0. 17

-1. 14

0. 08

0. 21

0. 05

1. 91

0. 12

2. 72

0. 21

M

2. 69

-1. 19

0. 05

1. 31

2. 45

SD

0. 47

0. 22

0. 20

0. 36

0. 27

＊1

Parameter (a): an indicator of the extent to which the respondent’s latent characteristics can be identified(characteristic value proportional to the slope of the item characteristic curve at ability value (θ) = b)
＊2
Parameter (b): Indicator of item difficulty (characteristic value representing the position of the item
characteristic curve)＊3
In this study, the GRM was employed and responses were requested using the five-case method, so four
difficulty parameters (b) were estimated for each item (Iwabuchi and Kato, 2018).
─ 65 ─

Journal of Developmental Disabilities Research No. 1+1 SD or higher) on the sub-threshold ASD traits questionnaire. There were 16 female high school
students (11.7% of the female students) with high scores (mean +1 SD or higher) on the subthreshold ADHD traits questionnaire. In addition, 13 female high school students (9.49% of the female
students) had high scores on both the sub-threshold ASD traits questionnaire and the sub-threshold
ADHD traits questionnaire. Twelve female high school students (8.8% of the female students) had
high scores only on the sub-threshold ASD traits questionnaire, and four female high school students(2.9% of the female students) had high scores only on the sub-threshold ADHD traits questionnaire.
Twenty-five female high school students (18.3% of the female students) had high scores (mean +1 SD
or higher) on the PMDD rating scale.
3.3

Gender Comparison on sub-threshold ASD and ADHD traits questionnaire
To begin, an unpaired t-test was conducted on the sub-threshold ASD traits questionnairescores of female and male high school students. The results showed no significant difference between
Table 2

Parameter estimates for each model (sub-threshold ADHD traits questionnaire)
Location Parameters ＊2 ＊3

Slope
Parameters ＊1

Item

1

2

3

4

a

Standard
ErrorbStandard
ErrorbStandard
ErrorbStandard
ErrorbStandard
Error

1. I have trouble remembering
things

1. 64

0. 12

-0. 87

0. 08

0. 70

0. 07

1. 73

0. 11

3. 26

0. 25

2. I have trouble withirregularity in my life

1. 67

0. 12

-1. 27

0. 09

0. 11

0. 06

1. 25

0. 08

2. 64

0. 17

3. I have trouble with my room
being so messy that I can't
invite people over

1. 42

0. 11

-1. 14

0. 09

0. 11

0. 07

1. 37

0. 10

2. 78

0. 18

4. I cannot do well when there
are multiple things that need
to be done

3. 60

0. 21

-1. 340. 09-0. 13

0. 04

0. 94

0. 06

1. 97

0. 13

5. I am always busy withthings that need to be done
and have no time to spare

2. 67

0. 16

-1. 440. 09-0. 08

0. 05

1. 12

0. 07

2. 27

0. 15

6. I get irritated easily

1. 94

0. 13

-1. 19

0. 08

0. 25

0. 06

1. 57

0. 10

2. 76

0. 19

7. I work hard, but the results
are not as expected

2. 02

0. 13

-1. 86

0. 12-0. 41

0. 06

1. 00

0. 07

2. 47

0. 16

M

2. 14

-1. 30

0. 08

1. 28

2. 59

SD

0. 76

0. 31

0. 35

0. 29

0. 41

＊1

Parameter (a): an indicator of the extent to which the respondent’s latent characteristics can be identified(characteristic value proportional to the slope of the item characteristic curve at ability value (θ) = b)
＊2
Parameter (b): Indicator of item difficulty (characteristic value representing the position of the item
characteristic curve)＊3
In this study, the GRM was employed and responses were requested using the five-case method, so four
difficulty parameters (b) were estimated for each item (Iwabuchi and Kato, 2018).
─ 66 ─

Journal of Developmental Disabilities Research No. 1

conditions (t (244.12) = 0.09, p = 0.93). Similarly, sub-threshold ADHD traits questionnaire scores (t(251.75) = 0.15, p = 0.88) did not differ significantly by gender.
3.4

Comparison of scores on the sub-threshold ASD and ADHD traits questionnaire by age
To begin, an unpaired t-test was conducted on the sub-threshold ASD traits questionnaire
Table 3

Parameter estimates for each model (PMDD Rating Scale)
Location Parameters ＊2 ＊3

Slope
Parameters ＊1

Item

1

2

3

4

a

Standard
ErrorbStandard
ErrorbStandard
ErrorbStandard
ErrorbStandard
Error

1. feeling depressed or
hopeless

4. 09

0. 38

0. 08

0. 05

0. 54

0. 07

1. 40

0. 13

2. 35

0. 24

2. feeling anxious or nervous

3. 89

0. 34

-0. 23

0. 06

0. 53

0. 07

1. 26

0. 11

2. 16

0. 20

3. tearfulness or sudden
sadness

2. 72

0. 27

0. 21

0. 07

0. 57

0. 08

1. 52

0. 14

2. 20

0. 21

4. Becoming angry or irritableor hitting others

2. 52

0. 22

-0. 42

0. 08

0. 55

0. 08

1. 21

0. 11

2. 20

0. 20

5. Loss of interest (in school,
hobbies, etc. )

3. 37

0. 31

0. 04

0. 06

0. 54

0. 07

1. 51

0. 13

1. 97

0. 18

6. difficulty concentrating

2. 81

0. 25

-0. 69

0. 08

0. 66

0. 08

1. 24

0. 11

2. 34

0. 22

7. Tiredness or loss of energy

2. 43

0. 22

-0. 77

0. 09

0. 55

0. 08

1. 12

0. 10

2. 13

0. 19

8. Increased appetite orcravings for certain foods(e.g., sweets, etc.)

1. 75

0. 17

-0. 65

0. 10

0. 21

0. 09

1. 02

0. 11

2. 24

0. 19

9. Sleeps more than usual

1. 50

0. 15

-1. 15

0. 13

0. 00

0. 10

0. 90

0. 11

2. 19

0. 19

10. Sleeps less than usual

1. 94

0. 21

0. 21

0. 09

0. 53

0. 09

1. 87

0. 17

2. 92

0. 31

11. Feeling out of control

3. 44

0. 32

0. 05

0. 06

0. 37

0. 06

1. 54

0. 14

2. 18

0. 21

12. Any of the following
physical symptoms (breast
pain or tightness, abdominal
tightness, abdominal pain,
headache, joint pain, muscle
pain, feeling swollen, weight
gain, constipation)

1. 84

0. 18

-0. 64

0. 10

0. 36

0. 09

1. 23

0. 12

2. 03

0. 17

M

2. 69

-0. 33

0. 45

1. 32

2. 24

SD

0. 86

0. 45

0. 19

0. 26

0. 24

＊1

Parameter (a): an indicator of the extent to which the respondent’s latent characteristics can be identified(characteristic value proportional to the slope of the item characteristic curve at ability value (θ) = b)
＊2
Parameter (b): Indicator of item difficulty (characteristic value representing the position of the item
characteristic curve)＊3
In this study, the GRM was employed and responses were requested using the five-case method, so four
difficulty parameters (b) were estimated for each item (Iwabuchi and Kato, 2018).
─ 67 ─

Journal of Developmental Disabilities Research No. 1

scores of female high school and college students. The results showed no significant differences
between conditions (t (232.36) = 0.20, p = 0.84). Similarly, there was no significant difference in scoreson the sub-threshold ADHD traits questionnaire (t (222.87) = 0.42, p = 0.67) due to age.
3.5

Comparison by age on PMDD rating scale scores (group with higher scores on sub-threshold
ASD and ADHD traits questionnaire)
Unpaired t-tests were conducted on PMDD rating scale scores for the groups with higherscores on the sub-threshold ASD traits questionnaire for female high school students and female
college students. The results showed a trend toward significant differences between conditions (t(28.51) = 1.95, p = 0.06). That is, female high school students with higher scores on the sub-threshold
ASD traits questionnaire (M = 35.13, SD = 9.56) were more likely to feel uncomfortable before
menstruation than female college students (M = 28.67, SD = 10.27). Similarly, an unpaired t-test was
conducted on PMDD rating scale scores for the group with higher scores on the sub-threshold
ADHD traits questionnaire. The results showed a significant difference between conditions (t (27.87)= 2.10, p = 0.05). That is, female high school students (M = 36.250, SD = 11.02) with higher scores on
the sub-threshold ADHD traits questionnaire were more uncomfortable before menstruation thanfemale college students (M = 29.00, SD = 8.30).
3.6

 omparison of PMDD assessment scores among high-scoring groups of female high schoolC
students on the sub-threshold ASD and ADHD traits questionnaire
A one-way ANOVA was conducted on the PMDD scores of female high school students in thegroups on the sub-threshold ASD-only (12 students) and on the sub-threshold ADHD-only (4students) and on students who fell within the overlap of both the sub-threshold of ASD and ADHD
(13 students), as well as on randomly selected typically developing students (29 students). The results
showed a significant main effect for female high school students with sub-thresholdneurodevelopmental disabilities traits with respect to the overall PMDD scores (F (3,54) = 40.72, p =0.00). The results of multiple comparisons (Holm method) showed that the with overlapping on the
sub-threshold ASD and ADHD groups (sub-threshold ASD: M = 31.92, SD = 7.93, sub-threshold
ADHD: M = 27.25, SD = 9.95, overlapping: M = 39.08, SD = 9.57) scored significantly higher on PMDD
than did typically developing students (M = 17.24, SD = 1.55) (sub-threshold ASD: t (54) = 6.77, Padj
= 0.00, sub-threshold ADHD: t (54) = 2.97, Padj = 0.01, duplicate: t (54) = 10.34, Padj = 0.00). Note that
there was no significant difference between the on the sub-threshold ASD-only group and the on
the sub-threshold ADHD-only group for overall PMDD scores (t (54) = 1.28, n.s.). Therefore, a onefactor analysis of variance was conducted for each item of the PMDD scale, and the main effect ofscores on the sub-threshold neurodevelopmental disabilities traits was found to be significant for theitem “feeling depressed or hopeless” (F (3,54) = 23.68, p = 0.00). In addition, a significant main effect of
sub-threshold neurodevelopmental disabilities traits scores was found for the item “feeling anxious
or nervous” (F (3,54) = 22.64, p = 0.00). Multiple comparisons (Holm method) showed that the on-thesubthreshold ASD-only group (M = 3.17, SD = 1.27) scored significantly higher on PMDD than theon-the-subthreshold ADHD-only group (M = 1.50, SD = 1.00) (t (54) = 3.36, Padj = 0.04).
3.7

 ub-threshold neurodevelopmental disabilities traits scores predict premenstrual unpleasantSmood and problems with school adjustment
A mediation analysis was conducted to prove whether PMDD is mediated by the assumptionthat sub-threshold neurodevelopmental disabilities traits affect school adjustment in female high
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Journal of Developmental Disabilities Research No. 1

school students. First, multiple regression analysis were conducted using scores on the school
adjustment item “It interfered with my efficiency in school life and studies” as the objective variable,
and with scores on sub-threshold ASD as the explanatory variable. The results showed that subthreshold ASD scores significantly predicted “It interfered with my efficiency in school life andstudies” (b = 0.10, SE = 0.02, t (135) = 5.37, p = 0.00). Furthermore, when PMDD scores were added
as explanatory variables, PMDD significantly predicted “It interfered with my efficiency in school lifeand studies” (b = 0.07, SE = 0.01, t (134) = 9.59, p = 0.00), while sub-threshold ASD effect became
non-significant (b = 0.02, SE = 0.02, t (134) = 1.50, p = 0.14). The results of the indirect effect test
(Bootstrap method, 2000 runs) showed that the 95% confidence interval ( [0.05,0.10] ) did not include 0,
indicating significant mediation of PMDD.
Next, multiple regression analysis was conducted using sub-threshold ADHD scores as the
explanatory variable. The results showed that sub-threshold ADHD scores significantly predicted “Itinterfered with my efficiency in school life and studies” (b = 0.12, SE = 0.02, t (135) = 6.78, p = 0.00).
Furthermore, when PMDD was added as an explanatory variable, PMDD significantly predicted “Itinterfered with my efficiency in school life and studies” (b = 0.07, SE = 0.01, t (134) = 8.67, p = 0.00).
The effect of sub-threshold ADHD scores was also significant but smaller (b = 0.04, SE = 0.02, t (134)= 2.29, p = 0.02).
Similarly, multiple regression analysis was conducted using the school adjustment item “Itinterfered with my relationships with people at school” as the objective variable and sub-threshold
ASD scores as the explanatory variable. The results showed that sub-threshold ASD scoressignificantly predicted “It interfered with my relationships with people at school” (b = 0.10, SE = 0.01,
t (135) = 7.17, p = 0.00). Furthermore, when PMDD scores were added as an explanatory variable,
PMDD significantly predicted “It interfered with my relationships with people at school” (b = 0.05,
SE = 0.01, t (134) = 6.88, p = 0.00). The effect of sub-threshold ASD scores was also significant, but
the effect was smaller (b = 0.06, SE = 0.01, t (134) = 4.00, p = 0.00).
Next, multiple regression analysis were conducted using sub-threshold ADHD scores as the
explanatory variable. The results showed that sub-threshold ADHD scores significantly predicted “Itinterfered with my relationships with people at school” (b = 0.08, SE = 0.02, t (135) = 4.93, p = 0.00).
Furthermore, when PMDD scores were added as explanatory variables, PMDD significantly
predicted “It interfered with my relationships with people at school” (b = 0.06, SE = 0.01, t (134) =7.51, p = 0.00), while sub-threshold ADHD scores effect became non-significant (b = 0.01, SE = 0.02, t(134) = 0.77, p = 0.45). The results of the indirect effect test (Bootstrap method, 2000 times) showedthat the 95% confidence interval ( [0.04,0.10] ) did not include 0, indicating significant mediation of
PMDD.

4.

Discussion

The analysis in this study showed, first, that female high school students with sub-threshold
ASD and ADHD were not significantly different from both male high school students and female
college students. Second, that female high school students with sub-threshold neurodevelopmental
disabilities traits were more uncomfortable before menstruation than female college students or
female high school students with typical development. In particular, female high school students with
sub-threshold ASD traits were more likely than female high school students with sub-threshold
ADHD traits to experience depressed or hopeless moods and to have higher levels of anxiety andtension. Since the results of this study indicate that four female high school students had sub─ 69 ─Journal of Developmental Disabilities Research No. 1

threshold ADHD traits, it is desirable to survey a larger number of subjects in the future.
The results showed that sub-threshold ASD scores among female high school students wereassociated with PMDD, summarized as “it interfered with my efficiency in school life and studies”.
Women with ASD experienced heightened sensory sensitivity and severe premenstrual symptoms
before menstruation, which have been proven to be related to the difficulty of living in ASD women(Noda et al., 2021). In addition, more than 75% of women with ASD who are aware of PMS symptoms,
tend to become hypersensitive due to changes in themselves, becoming aware of mental symptoms
like lethargy, difficulty concentrating, and crying before menstruation. In addition, there is evidenceof premenstrual changes in lifestyle behaviors such as poor performance, forgetfulness, and increased
compulsive behaviors (Kyrkou, 2005).
In addition, in the case of female high school students with sub-threshold ADHD traits, it wasdemonstrated that PMDD caused them to respond “It interfered with my relationships with peopleat school”. The prevalence of PMDD has been shown to be higher in women with ADHD comparedto the general female population (Dorani et al., 2021). In addition, prevalence differences for ADHDrelated mental disorders have also been demonstrated to be significantly greater in women than inmen for anxiety, depression, bipolar disorder, and personality disorders (Solberg et al.,2017).
Adolescence is a unique period in human development, both psychologically and physiologically.
In addition, it is a critical and vulnerable period between childhood and adulthood (Takeda etal.,2010). Many female high school students experience stress in their daily lives, and with little
accurate information on reproductive health, they may experience significant stress related to
menstruation. It has also been noted that when PMS and other symptoms occur, these females may
have negative thoughts that further reinforce premenstrual symptoms (Kitamura et al., 2012).
A woman with sub-threshold neurodevelopmental disabilities traits experience a state of helpseeking, which is noted when she expresses her difficulty in talking to others about her menstruation,
while seeking understanding from those around her (Noda et al.,2021). In order to promote
adjustment of female high school students with sub-threshold neurodevelopmental disabilities traits
to the school environment, reproductive health education should be actively provided in a standard
classroom accounting for sub-threshold neurodevelopmental disabilities traits. Furthermore, it isexpected that female students with sub-threshold neurodevelopmental disabilities traits will gain
understanding of their own difficulties from the female high school students around them, and willdevelop supportive techniques that facilitate good communication experiences with them.
Acknowledgments
We thank Dr. Anna Di Gregorio, Dr. Yutaka Nibu, and Ms. Marianna Nibu for editing the text
and critically reading the manuscript.

References
American Psychiatric Association (Ed.). (2013). Diagnostic and statistical manual of mental disorders. fifth
edition. Washington. DC: American Psychiatric Publishing.
Dorani. F., Bijlenga. D., Beekman. A. T. F., Someren. E. J. W., & Kooij. J. J. S. (2021). Prevalence of hormonerelated mood disorder symptoms in women with ADHD. Journal of Psychiatric Research, 133, 10-15.
Egawa, M. (2020). Menstruation‒associated Symptoms：Primary Dysmenorrhea and Premenstrual Syndrome/
Premenstrual Dysphoric Disorder. Japanese Journal of Psychosom Med, 60, 515-520. (In Japanese)
Eguchi. K. (2011). An examination of item characteristics of the Work Values Scale (short version): Based on
─ 70 ─

Journal of Developmental Disabilities Research No. 1

Item Response Theory. Hiroshima University management review, 11, 43-53. (In Japanese)
Ironson, G. H., Smith, P. C., Brannick, M. T., Gibson, W. M. & Paul, K. B. (1989). Construction of a Job in
General scale: A comparison of global, composite, and specific measures. Journal of Applied Psychology, 74(2), 193-200.
Iwabuchi, M & Kato, M. (2018). Developing a Four-point Scaled and Shortened Version of the University
Personality Inventory： Reliability and Validity of the UPI16T-GR. Annual Report Graduate School of
Education, Tohoku University 67 (1), 155-172. (In Japanese)
Kijima, N. (1999). Measuring Personality: The TCI Temperament and Personality Scale. Watanabe, N. &Noguchi, H. (Eds), Organizational Psychometrics: Frontiers of Item Response Theory. Hakuto Shobo. 179206. (In Japanese)
Kitamura, M., Takeda, T., Koga, S., Nagase, S. & Yaegashi, N. (2012). Relationship between premenstrual
symptoms and dysmenorrhea in Japanese high school students. Archives of Womenʼs Mental Health, 15,131-133. (In Japanese)
Kumagai, R. (2009). Development of IRT analysis programs for beginners : EasyEstimation series. Japanesejournal for research on testing, 5 (1), 107-118. (In Japanese)
Kyrkou, M. (2005). Health issues and quality of life in women with intellectual disability. Journal of Intellectual
Disability Research, 49 (10), 770-772.
Miyaoka, Y., Akimoto, Y., Ueda, K. & Kamo, T. (2009). The Reliability and Validity of the Newly Developed
PMDD scale. Journal of Japanese Society of Psychosomatic Obstetrics and Gynecology, 14 (2), 194-201. (InJapanese)
Noda, T., Sakaue, M. & Sengoku, Y. (2021). Premenstrual changes in physical and mental state experienced by
women with autism spectrum disorder (ASD) and their impact on daily living activities. Japanese Journalof Health and Human Ecology, 87 (3), 100‒112. (In Japanese)
Obaydi, H. & Puri, B. K. (2008). Prevalence of Premenstrual Syndrome in Autism: A Prospective Observerrated Study. The Journal of international medical research, 36 (2), 268-772.
Shimizu, H. (2016). An introduction to the statistical free software HAD: Suggestions to improve teaching,learning and practice data analysis. Journal of media, information and communication, 1, 59-73. (In Japanese)
Shinoda, H., Nakakuki, S., Shinoda, S. & Takahashi, T. (2017). Special needs related to developmental disorders
in college students and social skill training as a transitional support for perceived difficulties. The journal of
the Institute of Psychology, Rissho University (15), 7-17. (In Japanese)
Solberg, B. S., Halmøy, A., Engeland, A., Igland, J., Haavik, J. & Klungsøyr, K. (2017). Gender differences in
psychiatric comorbidity: a population-based study of 40 000 adults with attention deficit hyperactivity
disorder. Acta Psychiatrica Scandinavica, 137 (3), 176–186.
Takahashi, H., Iwabuchi, M., Suda, N., Oda, K., Yamazaki, I., Shinba, K. & Yamaguchi, T. (2015). Developmental
Disabilities-Related Difficulties Questionnaire Implementation Manual, 2nd ed. Sankeisha. (In Japanese)
Takeda, T., Koga, S. & Yaegashi, N. (2010). Prevalence of premenstrual syndrome and premenstrual dysphoric
disorder in Japanese high school students. Archives of Womenʼs Mental Health, 13, 535-537. (In Japanese)
Urakami, M. & Wakita, T. (2016). Using item response theory to create a short version of Urakami’s careerdecision-making self-efficacy scale. Academia. Humanities and natural sciences, Nanzan University, 67-76.
Yada (Hashimoto), M., Komira, H., Kawaguchi, H., Shimizu, A., Mitsuta,. N & Kurachi, H. (2017). Menstrual
disorders in adolescent girls and young women with intellectual and developmental disabilities. Japanese
Journal of Advances in Obstetrics and Gynecology, 69 (3), 245-252. (In Japanese)─ 71 ─

Journal of Developmental Disabilities Research〔JDDR〕
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