Support for Children with developmental disabilities in Japan

Hi Guys!

This will be my first time posting in Reddit. I have checked before posting but I could not find any post about what parents can do for their child who have developmental disabilities like ASD or ADHD.

First off, a little background.

I (a foreigner) am currently working as a clinical psychologist/public psychologist in Japan (Kansai region) and my specialty is in providing clinical assessments, counselling services for parents, and psychological/intervention programs for children with developmental disabilities. Normally, I would be working with Japanese clients but it seems to me that there is also an increase in different nationals, trying to seek for help for their children. Just recently, a couple brought their child over for assessment and was wondering what their options were and why intervention programs in Japan were so expensive. This prompted me to create this post and I would be happy if it is of any help to anyone.

The service that parents can take for their child is called 療育（りょういく）療 as for 治療（ちりょう）/Treatment, and 育 as for 教育（Kyouiku）/ Education. There are many 児童発達支援・放課後等デイサービス (じどうはったつしえん・ほうかごなどデイサービス) also known as Developmental Support and After School Services places you can go to, and these are the places to seek for intervention programs like behavioral therapy, speech therapy, occupational therapy, and many others depending on what your child needs and of course your needs too. Please note that most of the services provided are in Japanese.

Now, on to the main part of the post.

In my years working in Japan, I have also worked with children of different nationalities. When I talked to the parents, my heart always break when they tell me about how much money (around 3000-5000 yen) they had to spend just to go for 1 single lesson (nothing much can be done in 1 lesson, it’s all about long-term and consistency). There is absolutely no need to have private lessons. Most of the 児童発達支援・放課後等デイサービス centers (including mine) accepts what we call 障がい児の**受給者証**「じゅきゅうしゃしょう」(certificate of welfare?) which allows you to take your child to any of these 児童発達支援・放課後等デイサービス centers once a day (some regions limit the amount of days you can bring your child depending on the severity of his/her disabilities ) and caps the maximum amount of money you have to pay a month (depending on your salary). So for example: on the 受給者証 if it was to say 23/日 and 4600円, it would mean that you can have intervention programs for a maximum of 23 days per month and it all caps off at 4600 yen even if you were to use all 23 days. Of course it would be cheaper if you were to just use 1 or 2 days (around 200 yen?). Additionally, you do not have to pay if your child is in kindergarten. That is why I would always ask them to apply for the 受給者証 before we start any lessons.

To apply, many regions have their own procedure and I would really advise on checking on your nearest municipal hall’s website. As for my place, I find that it is always safe to

① Go to your nearest city hall and head over to the department of health, medicine, and welfare. Ask them you would like to apply for a 受給者証 and ask for the documents you need.

② Check up on your nearest 児童発達支援・放課後等デイサービス centers and see what they offer. If you are uncertain, you can always ask for a tour and check out the type of programs they have to offer. (療育を受けたいですが、その前にまず見学をさせていただけますか？)During this part, you can opt to go alone or with your child. Once you have decided, there would normally be an intake whereby you need to take your child with you. One staff might have a short interview with you while another interacts with your child to observe his/her behavior. Please bring along your 母子手帳 (mother-child handbook) in case they want to have a look at it.

③ Normally, you will need a letter of diagnosis（診断書） from a doctor. I would recommend going to a university hospital (or Osaka City General Hospital if you are in Osaka) since they would have English speaking staff to help you along. When you make a appointment with the doctor, it would be likely that the doctor ask that your child take a developmental assessment (K式発達検査 in the Kansai Region) with one of the clinical psychologist working there. Based on the results, the doctors would write up a letter of diagnosis or if there is no need for a diagnosis, he/she would write something like ‘OO’s child is advised to start intervention programs.’ Assessments if taken in Japanese would be covered by the National Health Insurance and should not cost a lot. 　

④Gather the remaining documents that your city halls need and your 受給者証 should be issued to you within a month or 2. Once you have it with you, you can call the 児童発達支援・放課後等デイサービス center and let them know that you have your 受給者証 with you. They would guide you from there. \*Please note that in most cases, there would be a need a sign a contract. I would strongly recommend that you bring your 受給者証 (they would need to add their info into it) and your hanko/stamp along with you.

⑤ You should be good to go. Please note that you can go to different 児童発達支援・放課後等デイサービス centers as you like. For example: Monday and Friday to OOCenter, Tuesday to XXCenter, and Saturday to YYCenter. **It is however not possible to go to two different centers on the same day.**

Additional Fact

\*Please note that there are two types of certificates. The 受給者証 and the 療育手帳（りょういくてちょう）handbook for 療育. The important one to get is the **受給者証** as it significantly reduces the amount you have to pay for therapy sessions. The 療育手帳 gives you discount for transportation or certain attractions you would like to go to with your child.

\*Assessments in Japanese are all covered by the Japanese National Health Insurance. For assessments in English, unfortunately, you would have to pay the full price.

Sorry for such a long post. I hope that this would be of help to anyone. Please remember, you are not alone in Japan. I know that the journey is hard but please do not carry all the burden by yourself.