［Paper］

The “Sense of Diﬃculty” Related to Developmental Disorders inJapanese High School Students: A Case Study of a

Teacherʼs

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‑related
diﬃculties (sense of diﬃculty: SOD) of students who use the health room, the seriousness of theirproblems, and their need for assistance. Five hundred
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 studentsʼ 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,
adaptation1.

teacher, School

Introduction

According to the Basic School Survey for FY2020 (MEXT, 2021), Japanʼs 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 non‑attendance, 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 large‑
scale 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 ʻKomarikanʼ 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 studentsʼ developmental
disorders. Furthermore, he proposed support methods that focus on university studentʼs “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 ateacher. A “teacher” is a special
licenced educator who supports childrenʼs 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 ofTeacher Education, 2003).
teachers accurately grasp the─ 53 ─

Journal of Developmental Disabilities Research No. 1

condition of studentsʼ 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 ofteachers who experienced continuous
support within approximately one year was 91.4%. A survey conducted onteachers in highschools also pointed out that manyteachers 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 withteachers 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 studentsʼ 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
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: co‑educational schools, boysʼ schools, and girlsʼ 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 andteachers (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
ʻexcessively absent or tardy, expelled or retained from school, or punished for student guidance─ 54 ─

Journal of Developmental Disabilities Research No. 1

problemsʼ 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“othersʼ 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 deﬁned
as 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 < .001), and multiple comparisons using Holmʼsmethod (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 deﬁned
as 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 ( (371) = 5.43, < .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 chi‑square test was conducted on the number of people in each group; a signiﬁcant relationship was= 373) = 16.40, < .001) The results of the chi‑square test showed a significant
found (χ2 (3,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 groupʼs 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. This
conﬁrmed 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% ofteachers cited developmental disorders as a background factor for high school
students who used the health room. This indicates that high school
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 “non‑ASD & 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 studentʼs 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,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.

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