A Preliminary Survey on Clinical Practice for Children and Adolescents with Gender Dysphoria in Japan: Current Situation and Challenges.

Little is known about the treatment of gender dysphoria among children and adolescents in Japan. This preliminary survey aims to improve understanding of current clinical practice for treatment of children with gender dysphoria. Subjects were 315 certified child and adolescent psychiatrists in Japan. The questionnaire asked about clinical experiences concerning gender dysphoria and gender identityrelated concerns. A total of 128 psychiatrists responded to the questionnaire. Mean length of clinical experience was 24.2±10.0 years in total and 16.9±11.5 years as child and adolescent psychiatry specialists. Among the respondents, 74 (57.8%) had seen children and adolescents with DSM-5 gender dysphoria, and 87 (67.7%) had examined cases with gender identity-related concerns. The mean number of experienced cases with gender dysphoria was 1.80±2.3 per respondent. We found that even among certified child and adolescent psychiatrists in Japan, experience with treatment of children with gender dysphoria was limited.

[A Questionnaire-based Study of Child Psychiatrists and Clinical Psychologists Regarding and Support for Children with Gender Identity Disorder and Sexual Problems].

In 2010, the Ministry of Education, Culture, Sports, Science and Technology (MEXT) in Japan strongly recommended that students with gender identity disorder (GID) who had behavioral health concerns should consult a professional in their schools. Furthermore, in 2015, MEXT subsequently announced that it is important for sexual minority students, including students with GID, to receive more support from professionals through cooperation with medical institutions. However, there has been no nationwide clinical research done on sexual minority youth, so little is known about how to optimally care for them in medical practice. This study assessed the current status of medical care for children and adolescents with GID and other atypical sexual development. The authors surveyed certifying physicians and councilors (315 people in total) of The Japanese Society for Child and Adolescent Psychiatry. The question obtained basic demographic and practice information and allowed for free responses on topics such as opinion on consultation and medical care for GID and atypical sex- ual development in childhood and adolescence. One hundred twenty-seven, or 40.3%, of those surveyed responded. The average number of years of total clinical experience was 23.9, and the average number of years of child psychiatric clinical experience was 18.8 years. The number of child psychiatrists who provided con- sultation for GID and other sexual development including transvestism and gender dysphoria were 88 (68.5%) and 105 (81.9%), respectively. The consultants' most frequent clients, in descending order, were: individuals, parents, and school officials. Seventy-four (57.5%) child psychiatrists provide medical care for patients with GID. In the preschool and elementary school age groups, consultants served many more (assignment) males than (assignment) females with GID, whereas in the higher elementary school and later ages, consultants served more females than males with GID equally often. In junior high school and later ages, consultants served more females than males with GID. Eighty-seven (67.7%) of the child psychiatrists provided medical care for patients with other sexual development. Before and during the mid- dle elementary school ages and in the high school ages, consultants served more males than females with other typical development, whereas in higher grade elementary and junior high school ages, consultants served more females than males with other typical development. The free response sections revealed a diversity of opinions, clinical course, and cooperation with other institutions. At present, among child psychiatrists, there are many different perspectives on clinical care for GID and other sexual development. Therefore, it will be necessary to systematically examine current scientific evidence and to establish consensus on best practices for clinical management.

Clinical features of functional hearing loss with inattention problem in Japanese children.

OBJECTIVE: Functional hearing loss is a condition in which hearing is lost without actual pathology. In children, inattention during pure tone audiometry may be due in part to functional hearing loss. This study examined the issue of inattention as a psychological trait by analyzing the clinical features of functional hearing loss children in Japan. METHODS: Using the ADHD-Rating Scale IV, 97 functional hearing loss children were screened for inattention (27 boys, 70 girls; mean age 9 years 5 months, range 5-17 years). Those with high levels of inattention (Inattention group) were compared with others (Attention group) for clinical features statistically. Furthermore observed psychological clinical features were described. RESULTS: 36.1% were categorized in the Inattention group, which had more boys, lower in age, and had more physical, developmental, and environmental problems than the Attention group. Two groups had very different psychological feature. CONCLUSIONS: In children's functional hearing loss, there exists a group with psychological trait of inattention. Three younger children 5-6 years old with attention problems showed no psychological problems, their FHL was considered to be caused by generalized maturation and development. Nearly all of the rest children showed psychological problems, supporting the notion that FHL in children is psychogenic in nature. Because clinical features in Inattention group children were different from the Attention group significantly, it was concluded that distinguishing the Inattention group as a subtype of functional hearing loss in children would be effective for both diagnosis and treatment. Larger scale studies with many angles needed for the inattention problem in FHL children.

Corpus callosum in patients with obsessive-compulsive disorder: diffusion-tensor imaging study.

PURPOSE: To prospectively examine microstructural white matter abnormalities in the corpus callosum (CC) of patients with obsessive-compulsive disorder (OCD), as compared with control subjects, and to investigate the relationship between diffusion-tensor (DT) imaging measures of the CC region and clinical symptoms of OCD. MATERIALS AND METHODS: Institutional review board approval was obtained, and each participant--or the participant's parent(s)--provided written informed consent. Sixteen patients with OCD (seven male, nine female; mean age, 28.7 years +/- 9.8 [standard deviation]) and 16 matched healthy volunteers (control subjects) (seven male, nine female; mean age, 29.9 years +/- 9.0) were examined. Mean diffusivity and fractional anisotropy (FA) were measured in five subdivisions of the CC. The paired t test was performed to compare the mean diffusivity or the FA in CC regions between the patients with OCD and the control subjects. RESULTS: There were no significant differences (rostrum, P = .15; genu, P = .88; rostral body, P = .12; isthmus, P = .77; splenium, P = .88) in mean diffusivity between the patients with OCD and the healthy volunteers. A significant reduction in FA was observed in the rostrum of the CC in patients with OCD compared with the rostral FA in the control subjects (P < .001). Higher FA in only the rostrum correlated significantly with lower Yale-Brown obsessive-compulsive scale score (r = -0.72, P = .002). CONCLUSION: Study results support the widely held view that the orbital prefrontal region is involved in the pathophysiology of OCD and indicate that the orbitofrontal circuit influences symptom severity in patients with OCD.

[Crime prevention in high-functioning pervasive developmental disorders with paraphilia].

Paraphilia refers to occasional concomitant disorders of pervasive developmental disorder (PDD). When a restricted interest of PDD is focused on a sexual object, paraphilia may be develop as a problematic symptom. However, having this concomitant disorder does not always result in criminal behavior. When the social interactivity of a particular patient with PDD is severely impaired, paraphilia could lead to a sex crime. Because pedophilia targets sacrifice innocent and defenseless children, it is critical to prevent such sex crimes by understanding the psychopathology of PDD with paraphilia, especially pedophilia. Two cases of male adolescents with high-functioning PDD and pedophilia were reported; one ended up committing a serious crime, and the other controlled his sexual impulse. The psychopathology of these two cases was similar; however, the outcome turned out to be quite different. The similarity and dissimilarity of these two cases were analyzed. We came to a conclusion that early intervention could be a key to prevent the development of criminal sexual behavior in PDD with paraphilia (pedophilia). Both patients became aware of pedophilia during adolescence and developed a depressive state at the time of consulting our clinic. In the first case, the patient stabbed a woman with a knife. He could not respect other people, including women he was sexually interested in and has always been preoccupied with his own peculiar ideas. He did not listen to other people's opinions and his abnormal thoughts had never been corrected because of his lack of ability to form interpersonal relationships. The second patient could control his sexual impulse. He has an ability to sympathize with the child he is sexually interested in and has confronted his sexual impulses. He could build interpersonal relationship with others and listen to other people's opinions. He made an effort to manage his sexual impulses positively through individual psychotherapy. He was diagnosed at the age of two years and started rehabilitation training soon after. He had some experiences of consulting people when he was in trouble. In the treatment and correctional education of pedophilia, some sort of special care regarding the characteristics of PDD is indispensable; e.g., pointing-out and explaining unacceptable behavior repeatedly, teaching the correct action concretely, and changing the pathological sexual preference into a constructive one, etc. These therapeutic approaches are quite different from controlling paraphilia without PDD. PDD adolescents with impaired social interactivity could be further helper if they are diagnosed at an earlier stage of their lives and managed appropriately. A sense of being accepted by others and also experiences of mutual interaction with others are particularly important for them. Professionals should be aware that an early and proper intervention method could prevent the later development of criminal behavior in PDD adolescents who suffer from a sense of incompatibility with others because of concomitant paraphilia.