tl:dr What do you make of this referral letter content(text at the bottom) for my kid to a child psychiatrist(which I asked for). How would you handle it at the new doctor visit?
Guys, help me parse this wild child psych referral letter. I hardly post, but I am stumped with how to take this and what to do about it, if anything. Please, any feedback, I’m so lost. I understand the Japanese, but not in the context of a medical referral.
I don’t want to add my own bias, but it’s hard to give context without doing that. Maybe read the referral contents at the bottom first and then come back here.
Context: We live in kuso inaka, and drive three hours to these hospitals. We saw this pediatrician four times. They diagnosed my kid with autism on the first visit, which I expected. The doctor wrote letters to school telling them to meet all my requested accommodations, never pushed back. Even so, my kid had many negative experiences at school and began exhibiting mental health symptoms.
The kid is also traumatized from the sudden death of their other parent a year and a half ago and also the symptoms of the other parent’s mental illness leading up to their death(they were very suicidal among other things, but the cause of death was pulmonary embolism).
The kid stopped attending school last October after the school began trying to enforce more “rules” and also this was the first year anniversary of my partner’s death. My kid has special ed (支援学級) and a dedicated teacher. After much debate and consults with the school counselor etc., the school agreed to some rule changes, but not until the next school year(6 months later).
So in preparation for a new school year with new teachers and new rules, which my kid is willing to try again depending on their new teacher’s vibe and clear, written expectations, I insisted on referral to child psych after reaching the end of the current pediatrician’s ability I’ll say.
Then they give me this referral letter and there are many differences to what we actually talked about with this doctor, like I am almost certain I told him how my partner died, that’s not what I studied in college, the school quotes him saying something completely different about lunch rules, and many guesses that he never even asked me about. I’m worried how this letter will affect the objectivity of the next doctor. Appointment is next week. How would you handle this with the next doctor?
Original referral text(English below):
“平素より大変お世話になります。児の特性が強く、さらにお母様 (米国出身) もASD 特性があります。母子ともに学校とうまくいかず悩んでおられます。父は児が1年生 の時に亡くなっておられます(原因は聞いていない)。また、学校とのトラブルは 給食のことが主です。学校の給食におけるローカルルール (給食を減らさずに全部 食べたらおかわりができる)があり、児は偏食のため減らしたいが好きなメニュー はおかわりしたい思いが強く、母子と学校の話し合いがもたれています。当初、私 と学校担任で連絡をとり、「学校のルールを続けるなら他児の気持ちもあるため担 任の先生と児で少しずつ歩み寄るためのルール作りが必要」とお話ししました。学 校の対応の詳細は分かりませんが、お母様からはその後の先生の対応が厳しくな り、担任からは教育委員会とも相談し問題解決に当たっていると聞いています。学校側は給食おかわりのルール撤廃を考えておられ、お母様も納得されていますが、 次年度からというスピード感のなさ (日本行政や文化的な差異)に疑問を持たれて います。
児は父の死、学校で担任に厳しくされたことによりPTSDとなっているため学校には行けていない、とお母様はおっしゃっていますが、実際は分かりません (母が学校とうまくいかないことで、給食の問題が解決するまで行かせていないのかもしれません)。お母様は大学の頃に心理の勉強もされていたようで、給食でお かわりさせないことがオペラント条件付けの「負の消去」に当たると認識されています。また、日本のおかわり制度をビュッフェ形式と捉えておられたり、残さず食 べることを虐待と捉えたりと、少し極端な面もあり、学校とうまくいかない状況は なんとなく理解は出来ます。紹介状を母が見たときに困らないように、紹介状に書 けないですが、伝えておきたいことを書かせていただきました。経過等は紹介状を” ( then the text is cut off by the end of the input field on the printed version I received, so not sure how much more there is and I assume it will be forwarded electronically to the next doctor)
Google translate (since posts are supposed to be in English. I understand the japanese words, but I’m just confused overall as to why or what he means to convey, I’m also autistic as he choose to include, so I struggle with subtext etc.):
“Thank you for your continued support. The child has strong characteristics, and the mother (originally from the United States) also has ASD characteristics. Both mother and child are struggling to get along with school. The father passed away when the child was in first grade (the cause of death is unknown). The main issue with school is lunch. There is a local rule at the school regarding lunch (seconds are allowed if the child eats all of their lunch without reducing it), and the child is a picky eater and wants to reduce their portion, but strongly wants seconds of their favorite dishes, so discussions have been held between the mother, child, and the school. Initially, I contacted the homeroom teacher and explained that "if the school rules continue, it is necessary for the teacher and the child to gradually create rules to compromise, considering the feelings of the other children." I do not know the details of the school's response, but the mother has told me that the teacher's response has become stricter since then, and the homeroom teacher has told me that they are consulting with the board of education to resolve the issue. The school is considering abolishing the rule regarding seconds at lunch, and the mother agrees, but she is questioning the lack of speed (due to differences in Japanese administration and culture) as the change will only take effect next year.
The mother says that her child is unable to attend school because he is suffering from PTSD due to his father's death and harsh treatment from his teacher, but the truth is unknown (it's possible the mother is having difficulties with the school and is keeping him home until the lunch issue is resolved). The mother studied psychology in college and recognizes that not allowing seconds at lunch constitutes "negative extinction" in operant conditioning. She also views the Japanese second-serving system as a buffet and considers eating all the food to be a form of abuse, showing some extreme views, which makes her difficulties with the school somewhat understandable. I've written down some things I wanted to convey, even though they can't be included in the letter of introduction, so that the mother won't be troubled when she sees it. Further details will be provided in the letter of introduction.”
For clarification the lunch rules being referred to:
There are regular portions and reduced portions for the students to choose. When students choose regular portions and finish all their food, they are allowed to get seconds during a specific window of time. When students choose reduced portions and finish all their food, they are NOT allowed to get seconds at all.
Also students who don't finish their food must apologize out loud before putting their food in the trash and returning their plates.
Also students are sometimes sent back when trying to return their plates and told to try harder and eat more, even though they say they are full. The students are told to keep eating small bites until lunch time is up, even if they say they are full.
Thanks for reading
by saltyyama