Aspergers in China

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No official data exists on how many children in China live with neurodevelopmental disorders, which include Asperger’s, autism spectrum disorder (ASD), and attention deficit hyperactivity disorder (ADHD). (Health care professionals generally categorize Asperger’s as a mild form of ASD.) A 2016 study by The Lancet concluded that China was home to the second-highest number of children under 5 who live with ASD, after India. The same study found that China had the highest number of children under 5 living with ADHD. (In the United States, around 1.1 percent of children between 3 and 17 years old have ASD, and around 6.8 percent have ADHD, according to the Centers for Disease Control and Prevention.)

While such disorders tend to be better understood in the West, most Chinese people lack awareness of neurodevelopmental disorders. Many parents and teachers fail to recognize the symptoms, especially if the child in question is intellectually high-functioning. As such, the majority of affected children can go undiagnosed. And even when parents suspect an underlying condition, it can be hard to get a diagnosis. Only 500 doctors in China specialize in child psychiatry — the branch of medicine that most commonly deals with neurodevelopmental disorders — compared to about 8,300 in the United States.

In addition, few Chinese schools have the resources to provide the specialist education such children need. While behavioral therapists are relatively commonplace at American public schools, they are virtually nonexistent in China. And although China had around 2,000 public special-needs schools in 2014, the vast majority catered to the audiovisually impaired and severely intellectually disabled. Children like Junjun, whose conditions significantly affect everyday life but are too mild to be addressed at special-needs schools, rarely receive the care they need. In the public-education system, they are frequently ostracized by classmates and teachers who don’t understand how to interact with them.

“As the teacher, it put a lot of pressure on me. I’m responsible for protecting their children from potential risks,” Dong says. Unlike in the U.S., where most teacher training courses include at least some training on how to integrate special-needs students into general education, Chinese teachers don’t get any. “It’s a shame we’re not told how to deal with such situations,” Dong says.

Despite parental pushback, the school argued that it were legally obliged to accommodate Junjun for the duration of his primary education. “Public schools like ours can’t turn anyone away — they have a right to education, too,” says Dong.

Many Western public schools keep special-education teachers on hand to cope with students with neurodevelopmental disorders. But few public schools in China have similar resources. At best, schools employ “mental health teachers” who provide consultations to children with psychological issues but usually lack knowledge of specific disorders like autism, Asperger’s, and ADHD.

A crucial difference, according to Rose, is that American schoolchildren with behavioral problems are given both “pull-out” sessions, when they and other such learners are removed from regular classes for individualized sessions with special-needs teachers, and “push-in” sessions, when they are encouraged to participate in regular classes. “The goal is that they improve so they get [increasingly regular] push-in sessions,” she says. “Essentially, we’re aiming to prepare them for society.”

Rose thinks that ELG’s rising numbers of Chinese children shows that public awareness of neurodevelopmental disorders is increasing, but that public resources to cope with affected children remains limited. “In recent years, [awareness] has really picked up in China — not to the point of other countries, but the conversation has started, and people are paying more attention to it,” she says. But she adds that, so far, the state has taken little interest in the cause, and most public-awareness organizations tend to focus on special-needs children prior to the age of 5 or 6, when kids typically start school.

In health care, too, China faces a dearth of specialists in developmental disorders. “Pediatrics, psychiatry, and general practice are the three weakest subjects in [Chinese] health care, because the three corresponding hospital departments generate the lowest profits,” says Chen Jun, the secretary of the Chinese Society of Psychiatry, adding that medical institutions therefore offer scant services for affected children. “At the Shanghai Mental Health Center [the city’s best-regarded psychiatric institution], there are only 20 beds in the children’s ward,” says Chen, who is also the director of clinical research at the center. “That’s half the size of any other department. The few doctors in child psychiatry are all overworked, because the demand is huge.”

The situation is exacerbated by the fact that many parents, often under pressure from schools, approach psychological counselors and not doctors in an effort to treat their children’s neurodevelopmental conditions, according to a recent report in China Youth Daily.