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子供の発達障害:行動観察のこと

 ある子供が発達上の遅れや障害があるかどうかの判別は難しい。子供の発育は個人差が大きく、同年齢の大部分の子供達が、ある時期までにこういう事ができるようになっているだろう、という大まかな目安はあるが、その通りにいかないからといってすぐに発達に遅れや障害があることにならない。

 あるお母さんから、最近電話があった。10ヶ月の子供が検診で発達のおくれがあるかもしれないと言われたそうだ。保健婦さんからの紹介で専門医に診てもらったところ、気になるほどの遅れでもなく、発育は順調な方だと言われ、少し安心したということだった。発達のおくれがあるかもしれないと言われたのは、10ヶ月でお座りがほとんどできていなかったから。ところが、その後お座りはまあまあできるようになり、今はつかまり立ちで移動できるほどに成長している。

 別の知り合いの子供は、ほとんどはいはいをせずに8ヶ月過ぎからつかまり立ちをし始め、10ヶ月を少し過ぎた今、もう少しで歩きそうな所まできている。こんな風に、一人で立って歩けるまでの過程は子供によって多少違うこともある。

 運動能力だけでなく、言葉の発達も同じだ。
 ぴょろは2歳の検診で、発語が遅いと言われた。確かに、こちらが話しかけても指を指すとか、体での意思表示が主でほとんど言葉らしい言葉が出ていなかった。3歳を過ぎてもあまり状況が変わらないなら、相談に行こうと考えていたところ、2歳半過ぎに、ちょっとした事をきっかけに言葉がどんどん出るようになり、気がつくとたいそうなおしゃべりになっていた。私の予想通りにはいかなかったが、ちゃんと育っていたのだ。

 発達障害の疑いがあると、病院では検査を行う。知能検査や心理テストを使うことが多いが、これらは発達状況に関して一部分の情報しか得られないので、子供の様子を心理士あるいは主治医などの別のスタッフが観察し、テストとあわせて総合的に判断するというのが一般的だ。しかしこの方法も、まったく問題がないわけではない。子供の様子をどう評価するかは、どの観察者でも全く同じというわけではないからだ。そのため、できるだけ客観性を持たせるために、「子供の行動チェックリスト」のように、観察する項目をきちんと決めたものもあるが、それでも主観的な評価を完全に取り除くことはできない。したがって、複数のスタッフで一人の子供の様子を観察し、その結果を持ち寄って最終的な評価を決めるのが望ましいと言われている。

 大学院では、そう習ったのだが、実際に病院では一人でテストと行動観察を受け持つことがほとんど。したがって、自分の評価で診断が左右されるかもしれないというプレッシャーもかかる。さらに、子供達は病院というなれない環境で、狭い部屋で知らない人と一緒にいるというストレスもあるため、いつもとは違う行動を見せることも多いので評価はますます難しくなる。

 民間のカウンセリングルームでは、それらの問題点を配慮して、発達障害かどうかの判定が必要な時にはいくつかのルールが設けられている。基本的に、心理テストと行動観察を同じ人が受け持つことは変わらないが、評価が難しい時には、専門医やベテラン心理士の助言やサポートが受けられるようになっている。また、必要によっては、カウンセリングルームでの様子に加え、心理士が子供の自宅に訪問して、普段に近い状況での様子を観察することがある。

 広汎性発達障害の疑いがある場合には、きょうだい同士の関わりや、遊び方など、自宅での様子を知ることがとても大切なこともある。行動観察の仕方などはある程度の基準はあるが規則はないので、いろんな経験の中からこうした方がいいと気付いた事や改善したほうがいいと感じた事を加えながら、やり方を少しずつ変えてきた。両親から聞いた子供の様子、行動観察、心理テスト…とできるだけ広く情報を集めた上で、その子の発育がいわゆる正常の範囲内に入るのかどうかを細かくチェックしていくのが私のやり方。同業者からは、かなり慎重なタイプと見られているみたいだ。
Sana式の観察法は、まだ発展途上だし、本当に適切かどうかは分からない。それでも、日々ベストを尽くしたいと思っている。私たちの判断がその子供の進む道に与える影響を考えると、慎重すぎるくらいであっていいかなと思う。
 

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