Getting a Diagnosis for Your Child in Japan

For many parents, that first moment of realizing something might be different happens quietly. Maybe you have been watching your child and noticing that they are not quite reaching the same milestones as other children their age. Maybe they are not babbling yet, or not making eye contact, or not responding when you call their name. Sometimes you cannot even put your finger on what it is, you just feel it.

For other families, it comes up during one of Japan’s mandatory infant health checks, when a nurse or psychologist gently suggests follow-up. And sometimes it is a teacher at preschool or daycare who spends time with your child every day and quietly pulls you aside to share what they have been noticing. However it happens, it can be a confusing and emotional time. If you are in that place right now, know that there are professionals in Japan who can look at your child’s development with you and help you figure out what comes next.

Where Everything Begins

If you are a parent in Japan and you have started to feel that something about your child’s development might be different, I hope this article helps. A diagnosis might sound overwhelming right now, but it is the key that unlocks almost every support and service available to your family in Japan: therapy, special education placements, financial allowances, tax benefits, disability discounts, and more. Without one, most of those doors stay closed.

I have tried to lay out the full process here, step by step, from the moment you first sense that something might be different to the day you receive a diagnosis. For information about the disability handbooks (techou / 手帳) that come after a diagnosis, see the separate articles on each handbook on this site.

Japan’s Mandatory Health Checks

Nyuuyouji Kenkou Shinsa / 乳幼児健康診査

Japan has a system of mandatory health checks for all children, administered by your municipality. These checks are free and are conducted at your local hoken sentaa (保健センター), the community health center. They are one of the primary ways that developmental concerns are identified early in Japan.

The two most important checks for developmental screening are:

The 1.5-Year Health Check (Issai Rokukagetsu Ji Kenkou Shinsa / 1歳六か月児健康診査)

This check screens for basic developmental milestones including walking, pointing, simple words, eye contact, and social responsiveness. The National Center for Rehabilitation notes that by 18 months, the foundations of social communication should be emerging: joint attention, pointing to share interest, and early language. This check is specifically designed to catch delays in these areas.

If the assessments identifies any concerns, the health center may recommend youkansatsu (要観察), meaning follow-up observation, or refer you to a specialist.

The 3-Year Health Check (Sansai Ji Kenkou Shinsa / 3歳児健康診査)

This check is more comprehensive. By age 3, children are expected to be speaking in sentences, engaging in pretend play, following simple instructions, and interacting with other children. The check screens for language delays, behavioral concerns, cognitive development, hearing, vision, and overall health. Developmental concerns that were not apparent at 18 months may become clearer by this age.

Other Health Checks

Municipalities may also offer health checks at other ages (3 to 4 months, 9 to 10 months, and sometimes at 5 years). The specific schedule varies by municipality. All of these checks include a developmental screening component.

What Happens If Concerns Are Flagged

If the health check identifies a concern, the health center will not give a diagnosis on the spot. Instead, they will typically do one of the following:

• Youkansatsu (要観察) / Follow-up observation: You may be asked to come back in a few months for another check to see how your child’s development progresses.
• Oyako Kyoushitsu (親子教室) / Parent-child group: Some health centers run group sessions where parents and children with developmental concerns can interact with staff and each other, while professionals observe the child’s development over time.
• Referral to a specialist: You may be referred to a developmental disability support center (hattatsu shougai sha shien sentaa / 発達障害者支援センター), a child consultation center (jidou soudanjo / 児童相談所), or a medical institution for a formal assessment.

Getting a Referral

If you have concerns about your child’s development, you do not have to wait for a health check to bring them up. You can take that step yourself, and it starts with your pediatrician.

Ask Your Pediatrician for a Referral Letter

This is how most families begin. To see a specialist in Japan, you will need a referral letter (shoukai jou / 紹介状) from your child’s pediatrician (shounika i / 小児科医). When you go, tell them specifically what you have been noticing and ask them to refer your child to a shouni shinkeika (小児神経科, pediatric neurology), jidou seishin ka (児童精神科, child psychiatry), or hattatsu gairai (発達外来, developmental outpatient clinic), depending on what your pediatrician recommends. If you do not yet have a pediatrician, your local health center can help you find one.

If You Are Not Sure Where to Start

When you feel unsure or overwhelmed and want to talk things through before going to your pediatrician, there are two places that can help:

Your local hoken sentaa (保健センター, health center) offers free developmental consultations called hattatsu soudan (発達相談). You can call or visit without an appointment at most locations. A public health nurse (hokenshi / 保健師) will listen to your concerns and help you figure out what to ask your pediatrician for.

The hattatsu shougai sha shien sentaa (発達障害者支援センター, Developmental Disability Support Center) is a free, government-funded center that provides consultation, information, and guidance for families. They can help you understand the system and point you toward the right medical institution. You do not need a diagnosis or a disability handbook to contact them. You can find your nearest center at hattatsu.go.jp.

Neither of these places writes the referral letter itself, but both can help you feel more prepared and supported when you go to your pediatrician to ask for one.

Can You Go Directly to a Specialist?

Some smaller clinics and developmental outpatient clinics will accept patients without a referral letter. However, most specialists and nearly all hospitals require one. University hospitals will charge an additional fee if you arrive without a referral. It is always best to call the medical institution first and ask whether they require a shoukai jou before booking.

Which Specialist Sees Your Child?

The diagnosis of developmental disabilities and intellectual disabilities in children is done by medical doctors with specific specializations. The main departments are:

Department	What They Diagnose
Shouni Shinkeika (小児神経科) Pediatric Neurology	Developmental delays, intellectual disability, epilepsy, motor disorders, neurological conditions
Jidou Seishin Ka (児童精神科) Child Psychiatry	Autism spectrum disorder (ASD), ADHD, behavioral concerns, emotional difficulties, anxiety
Hattatsu Gairai (発達外来) Developmental Outpatient	General developmental assessment across all areas, often available at children’s hospitals
Shounika (小児科) Pediatrics (specialist)	Some pediatricians specialize in developmental pediatrics and can diagnose common conditions

University hospitals (daigaku byouin / 大学病院) and children’s hospitals (kodomo byouin / こども病院) typically have one or more of these departments. They are often the best option for complex cases, but waiting times can be long (sometimes several months).

What Happens During the Assessment

A developmental or disability assessment is not a single test. It is a process that typically includes several components:

The Interview (Monshin / 問診)

The doctor will ask you detailed questions about your child’s development, behavior, and daily life. This includes questions about pregnancy and birth, when your child reached milestones (sitting, walking, first words), current abilities and difficulties, behavior at home and in group settings, family history, and your specific concerns. This interview is extremely important because the doctor relies heavily on the parent’s observations.

Tip for foreign parents: Write your answers down in advance. If your Japanese is limited, prepare a written summary of your child’s developmental history in Japanese (with help from a friend, partner, or translation service). Bring it to the appointment. This ensures nothing important is lost to the language barrier.

Observation (Kansatsu / 観察)

The doctor and other professionals (psychologists, therapists) will observe your child during the appointment: how they move, how they interact with objects, how they respond to people, how they communicate, and how they handle the unfamiliar environment. For young children, much of this observation happens through play.

Developmental and Intelligence Tests

Depending on your child’s age and the concerns being evaluated, the assessment may include standardized tests. These are administered by trained psychologists (shinri shi / 心理士) or developmental specialists. The most commonly used tests in Japan include:

• Shin-ban K-shiki Hattatsu Kensa (新版K式発達検査) / New K-type Developmental Test: A Japanese-developed test used from birth to adulthood (primarily for children under 7). It evaluates three areas: posture and movement, cognition and adaptation, and language and social skills. This is the most widely used developmental test in Japan and is commonly used for ryouiku techou assessments at the jidou soudanjo.
• Tanaka-Binet Chinou Kensa (田中ビネー知能検査) / Tanaka-Binet Intelligence Test: A Japanese adaptation of the Stanford-Binet intelligence test. Measures overall intellectual ability and produces an IQ score. Used for school-age children.
• WISC (ウェクスラー式知能検査): An internationally used intelligence test administered to children aged 5 to 16. It measures verbal comprehension, perceptual reasoning, working memory, and processing speed. Used widely in Japan for educational and diagnostic assessments.

These tests are not pass/fail. They provide a detailed picture of your child’s developmental strengths and weaknesses, which helps the doctor make a diagnosis and helps you and your child’s support team plan the right interventions.

Additional Tests

Depending on the child, the doctor may also order hearing tests (to rule out hearing loss as a cause of language delays), blood tests, brain imaging (MRI), or genetic testing. These are not routine but may be recommended in specific cases.

What the Diagnosis Looks Like

After the assessment is complete, the doctor will give you a diagnosis. This typically happens in a follow-up appointment where the doctor explains the results. The diagnosis is documented in a shindan sho (診断書), a medical diagnosis certificate.

Common diagnoses for children include:

• Chiteki Shougai (知的障害) / Intellectual Disability: Significant limitations in intellectual functioning and adaptive behavior.
• Jiheishou Supekutoramu Shou (自閉症スペクトラム症) / Autism Spectrum Disorder (ASD): Differences in social communication, interaction, and patterns of behavior.
• Chuui Kekkan Tadou Shou (ADHD) (注意欠陥多動症): Difficulties with attention, hyperactivity, and impulsivity.
• Hattatsu Sei Kyouchou Undou Shougai (DCD) (発達性協調運動障害): Difficulties with coordination and motor skills.
• Gengo Shougai (言語障害) / Language Disorder: Significant delays in speech and language development.

Some children receive more than one diagnosis. For example, a child may be diagnosed with both autism spectrum disorder and intellectual disability.

What the Diagnosis Document Contains

The shindan sho (diagnosis certificate) from the doctor will typically include your child’s name, date of birth, the diagnosis, a description of the assessment findings, and any recommendations. This document is important because you will need it for:

• Applying for a disability handbook (techou)
• Applying for the service authorization certificate (tsuusho jukyuusha shou)
• Enrolling in therapy and developmental support services
• Applications for financial allowances

For details on what to do after receiving the diagnosis, see our the page on Disability Handbooks and Recipient Certificates.

Finding Diagnosis Services in English

Getting a diagnosis in a language you do not fully understand is stressful. The assessment relies heavily on the parent interview, and if you cannot communicate your observations clearly, important information may be lost.

Here are options for finding English-language diagnosis support:

• AMDA International Medical Information Center: Call AMDA for a referral to an English-speaking pediatric specialist in your area. Phone: 03-6233-9266 (English hours: Monday to Friday, 10:00 AM to 4:00 PM). See our article “Finding English-Speaking Doctors and Therapists” for full details.
• University hospitals: Doctors at university hospitals are more likely to speak English or to have international patient coordinators who can assist.
• International clinics: In major cities, international clinics with English-speaking staff may be able to conduct assessments or refer you to a specialist.
• The MHLW medical search tool: Use the Medical Information Net “NAVI” (医療情報ネット「ナビイ」) to search for medical institutions by language and specialty.

Medical institution search: Medical Information Net (NAVI)

What If You Cannot Find an English Speaker?

In many parts of Japan, getting a diagnosis in English will not be possible. If you need to go through the process in Japanese, here are strategies:

• Write a detailed developmental history in English and have it translated into Japanese before the appointment. This is the most important document you can prepare.
• Ask a Japanese-speaking friend, partner, or volunteer interpreter to come with you to the appointment.
• Ask your municipality whether medical interpreter services (iryou tsuuyaku / 医療通訳) are available.
• AMDA offers telephone-based medical interpretation that can be used during appointments.
• Ask the doctor to write down key points. Even if you cannot follow the spoken conversation fully, having the results in writing means you can translate them at home.

How Long Does It Take?

The timeline from first concern to formal diagnosis varies significantly:

• Getting an appointment: Specialist clinics and hospitals, especially in urban areas, may have waiting times of one to six months. Popular developmental outpatient clinics can have even longer waits.
• The assessment itself: May take one to three visits depending on the complexity of the case and the tests required.
• Receiving the diagnosis: Some doctors give the diagnosis at the end of the assessment. Others schedule a follow-up appointment to discuss results.

The long waiting times are frustrating. While you are waiting for the specialist appointment, you can start other processes that do not require a formal diagnosis: contacting the health center, visiting the developmental disability support center for consultation, and learning about the services available in your area.

Practical Tips

• Do not wait. If you have concerns about your child’s development, act on them. Contact your health center or pediatrician now. Early diagnosis leads to earlier intervention, which leads to better outcomes.
• You do not need to know what is “wrong.” You do not need to arrive with a suspected diagnosis. Simply saying “I am worried about my child’s development” or “my child is not speaking” is enough to start the process.
• Prepare a written developmental history. Whether the appointment is in English or Japanese, having your child’s history written down ensures you do not forget important details in the stress of the appointment.
• Bring your boshi techou (母子手帳), the maternal and child health handbook, to every appointment. It contains your child’s growth records and health check results.
• Attend every scheduled health check. These are free, mandatory, and specifically designed to catch developmental concerns early. Do not skip them.
• Ask for a copy of all test results and the diagnosis document. Keep these in a safe file. You will need them for certificate applications, service applications, school enrollment, and more.
• A diagnosis is not a label. It is a key that opens doors to support. Many parents feel relief after a diagnosis because it gives them a framework for understanding their child and a pathway to help.
• After receiving a diagnosis, the next steps are applying for a disability certificate and getting your child approved for services. See our articles on the Ryouiku Techou and “How to Get Your Child Approved for Disability Services.”

Key Terms

Japanese Term	English
Nyuuyouji kenkou shinsa / 乳幼児健康診査	Infant/toddler health check
Hoken sentaa / 保健センター	Community health center
Hattatsu soudan / 発達相談	Developmental consultation
Shoukai jou / 紹介状	Referral letter
Shouni shinkeika / 小児神経科	Pediatric neurology
Jidou seishin ka / 児童精神科	Child psychiatry
Hattatsu gairai / 発達外来	Developmental outpatient clinic
Shindan sho / 診断書	Medical diagnosis certificate
Hattatsu kensa / 発達検査	Developmental test
Chinou kensa / 知能検査	Intelligence test
Shinri shi / 心理士	Psychologist
Hokenshi / 保健師	Public health nurse
Youkansatsu / 要観察	Follow-up observation
Boshi techou / 母子手帳	Maternal and child health handbook

Useful Resources

Hattatsu Shougai Jouhou Navi Portal (developmental disability information, government): https://hattatsu.go.jp/

Hattatsu Shougai Navi: Significance of Medical Consultation (医療受診の意義と診断までの流れ): https://hattatsu.go.jp/supporter/healthcare_health/significance_of_medicalconsultation/

National Center for Rehabilitation: Health Check Discovery (健診での気づき): https://www.rehab.go.jp/ddis/aware/baby/check/

National Center for Rehabilitation: Early Discovery of Developmental Disabilities (発達障害の早期発見に関わる情報): https://www.rehab.go.jp/ddis/aware/info/

Children and Families Agency (CFA): Infant Health Checks Overview (乳幼児健診に関する取組み): https://www.cfa.go.jp/policies/boshihoken/nyuyojikenshin

MEXT: Systems Related to the Discovery of Disabilities (障害の発見にかかわる主な制度): https://www.mext.go.jp/a_menu/shotou/tokubetu/material/021/012.htm

MHLW: Medical Information Net NAVI (医療情報ネット): https://www.iryou.teikyouseido.mhlw.go.jp/znk-web/juminkanja/S2300/initialize

AMDA International Medical Information Center: https://www.amdamedicalcenter.com/