If your child has been diagnosed with autism (jiheishou supekutoramu shougai / 自閉症スペクトラム障害), ADHD (chuui ketsujo tadousei shougai / 注意欠陥多動性障害), or another developmental or mental health condition, their doctor may at some point recommend medication. In Japan, getting that medication is not as simple as getting a prescription and picking it up. There is a process, and understanding it ahead of time will save you a lot of confusion.
This article walks through that process step by step: how to find the right specialist, how to make the appointment, what happens at the first visit, how prescriptions and refills work, what to expect at the pharmacy, and what changes when your child becomes an adult.
Step 1: Find a Specialist Who Can Prescribe
Your regular pediatrician (shounika i / 小児科医) can diagnose many developmental conditions, but in most cases they cannot prescribe psychiatric or developmental medication. For that, you need to see a specialist. The main types of specialists who prescribe medication for children with developmental disabilities in Japan are:
- Jidou seishin ka (児童精神科, child psychiatry): Psychiatrists who specialize in children and adolescents. This became an officially recognized specialty in Japan in 2008. These doctors diagnose and treat mental health conditions and developmental disabilities in children, and they can prescribe all relevant medications.
- Shouni shinkeika (小児神経科, pediatric neurology): Pediatric neurologists who specialize in brain, nerve, and developmental conditions in children. Many shouni shinkeika doctors also diagnose and treat ADHD and autism and can prescribe medication.
- Hattatsu gairai (発達外来, developmental outpatient clinic): Specialized outpatient clinics within hospitals or standalone clinics focused on developmental disabilities. The prescribing doctor may be a child psychiatrist or a pediatric neurologist.
These specialists are found at:
- University hospitals (daigaku byouin / 大学病院)
- Children's hospitals (kodomo byouin / こども病院)
- General hospitals with a child psychiatry or pediatric neurology department
- Standalone mental health clinics (mentaru kurinikku / メンタルクリニック) that see children
There are far fewer child psychiatrists and pediatric neurologists in Japan than are needed, especially outside of major cities. Wait times for an initial appointment can be long, sometimes 2 to 6 months or more. This is why starting the process early is so important.
To find a specialist in your area, you can:
- Ask your pediatrician for a referral (shoukai jou / 紹介状). This is the most common pathway.
- Search the MHLW Medical Information Net (iryou jouhou netto / 医療情報ネット) to find hospitals by specialty and area.
- Check the Japan Society of Child Neurology's specialist directory, which lists pediatric neurologists by prefecture.
- Contact the hattatsu shougai sha shien sentaa (発達障害者支援センター, Developmental Disability Support Center) in your prefecture for guidance.
Step 2: Make the Appointment
Once you have identified a specialist, you will need to call the hospital or clinic to make an appointment. In Japan, most specialist appointments for children with developmental disabilities require advance booking. Walk-ins are generally not accepted for initial consultations.
When you call, you can say: "hattatsu shougai no kodomo no shinryou yoyaku wo shitai no desu ga" / 発達障害の子どもの診療予約をしたいのですが (I would like to make an appointment for my child with a developmental disability).
They will likely ask:
- Your child's age and name
- Whether your child has been diagnosed and with what
- Whether you have a referral letter (shoukai jou / 紹介状) from your pediatrician
- Whether your child is currently taking any medication
A referral letter is strongly recommended and sometimes required, especially at larger hospitals. University hospitals will typically charge an additional fee if you arrive without one. If you do not have a referral letter, ask your pediatrician to write one before calling the specialist.
Be prepared for a long wait. Initial appointments at child psychiatry and pediatric neurology clinics can have wait times of several months. If the wait is very long, ask whether there is a cancellation list you can be placed on.
Step 3: The First Visit
At the first visit, the specialist will conduct a thorough evaluation. This may include:
- A detailed interview with you about your child's developmental history, current behavior, daily life, and any concerns
- Observation of your child
- Review of any existing diagnostic reports, test results, or school records you bring
- In some cases, additional developmental or psychological testing
Bring everything you have: your child's boshi techou (母子手帳, mother and child health handbook), any previous diagnostic reports, school reports, therapy records, and a list of your specific concerns. If you have documents in English, bring them along with any Japanese translations you can prepare.
The doctor may not prescribe medication at the first visit. They often want to observe your child over multiple visits before deciding whether medication is appropriate. Medication is generally considered after other approaches, such as therapy, environmental adjustments, and behavioral strategies, have been tried or are being used alongside it.
Step 4: Understanding the Medications Your Doctor May Prescribe
It is helpful to know what types of medications exist so you are not caught off guard when your doctor brings them up. Medication for developmental disabilities does not cure the underlying condition. For ASD, there is currently no medication that treats the core characteristics. For ADHD, medication can help manage specific symptoms like inattention, hyperactivity, and impulsivity. In both cases, medication is a tool used alongside therapy and environmental support.
Medications for ADHD
From research, I found there are four main medications prescribed for ADHD in children in Japan:
| Brand Name | Japanese | Generic Name | Note |
| Concerta | コンサータ (konsaata) | Methylphenidate | Requires registered doctor and patient registration |
| Strattera | ストラテラ (sutoratera) | Atomoxetine | No special registration needed. Generics available. |
| Intuniv | インチュニブ (inchiunibu) | Guanfacine | No special registration needed |
| Vyvanse | ビバンセ (bibanse) | Lisdexamfetamine | Children only. Requires registration (same system as Concerta) |
Important: the Concerta and Vyvanse registration system. Concerta and Vyvanse are classified as controlled substances in Japan because of their potential for dependency. They can only be prescribed by doctors who are registered in the ADHD Proper Distribution Management System (ADHD tekisei ryuutsuu kanri shisutemu / ADHD適正流通管理システム). Not every psychiatrist or neurologist is registered. Before your appointment, check whether the hospital or clinic has a registered prescribing doctor (touroku i / 登録医) if you think your child may need Concerta or Vyvanse.
If your doctor prescribes Concerta or Vyvanse, your child will also need to be registered as a patient in the management system. The doctor handles this registration. You may be asked to present identification, and at the pharmacy you will need to show ID as well.
Medications for ASD-Related Symptoms
There is no medication that treats the core characteristics of autism (social communication differences, restricted and repetitive behaviors). However, medication may be prescribed for associated symptoms that significantly affect daily life, such as irritability, severe tantrums, aggression, self-injury, anxiety, or sleep difficulties. The main medications used are:
| Brand Name | Japanese | Generic Name | Approved For |
| Risperdal | リスパダール (risuperdaaru) | Risperidone | Irritability associated with ASD (ages 5-17) |
| Abilify | エビリファイ (ebirifai) | Aripiprazole | Irritability associated with ASD (ages 6-17) |
Your doctor may also prescribe other medications for specific symptoms such as sleep problems, anxiety, or epilepsy, depending on your child's needs. The decision about medication is always made on an individual basis between you and your child's doctor.
Step 5: How Prescriptions and Refills Work
This is one of the biggest differences between Japan and many other countries. In Japan, you cannot simply call your doctor and ask for a prescription refill. For ongoing psychiatric and developmental medication, you must visit the doctor in person each time you need a new prescription. There are no automatic refills and no phone-in prescriptions for these types of medications.
How often you need to visit depends on the medication and your child's situation:
- During the initial phase (when the doctor is adjusting the dosage or monitoring side effects), visits may be every 2 to 4 weeks.
- Once the medication and dosage are stable, visits are typically every 4 to 12 weeks, depending on the doctor and the medication.
- For Concerta and Vyvanse, the maximum prescription period is 30 days at a time, which means monthly visits are required for as long as your child takes the medication.
At each visit, the doctor will ask how the medication is working, whether there are any side effects, and whether the dosage needs to be adjusted. These are not just paperwork visits. The doctor is evaluating your child each time.
After the visit, the doctor gives you a prescription (shohousen / 処方箋). You take this to a pharmacy to have it filled.
Step 6: Filling the Prescription at the Pharmacy
In Japan, most prescriptions are filled at an outside pharmacy (chouji yakkyoku / 調剤薬局), not at the hospital itself. After your appointment, take your prescription to a nearby pharmacy. Most hospitals and clinics have pharmacies nearby or can tell you which pharmacy to use.
At the pharmacy, the pharmacist will:
- Confirm the prescription and the medication
- Ask whether your child has any allergies or is taking other medications
- Explain how to take the medication (dosage, timing, with or without food)
- For Concerta and Vyvanse, ask to see your ID and verify your child's registration in the management system
The pharmacy will keep a record of all your prescriptions in a okusuri techou (お薬手帳, medication handbook). This is a small booklet that tracks every medication your child takes. Bring it to every pharmacy visit and every doctor visit. It is important because it helps your doctor and pharmacist see the complete medication history.
You pay for the medication at the pharmacy. The cost depends on your health insurance and whether you have a jiritsu shien iryou jukyuusha shou (自立支援医療受給者証, self-support medical care recipient certificate), which can reduce your out-of-pocket share significantly. See below for details.
Reducing the Cost of Ongoing Medication
If your child sees a specialist regularly and takes ongoing medication, the costs can add up. The jiritsu shien iryou (自立支援医療, self-support medical care) program can reduce your out-of-pocket share from the standard 30% to 10%, with an income-based monthly cap. This applies to both the doctor visits and the pharmacy costs, as long as both are at designated providers.
To use this program, you need to apply for a jiritsu shien iryou jukyuusha shou (自立支援医療受給者証) at your city or ward office welfare desk. When you apply, you designate both your hospital/clinic and your pharmacy. The reduced rate only applies at those designated providers.
See the standalone article on the Jiritsu Shien Iryou Jukyuusha Shou on this site for the full application process. If your child is also applying for the seishin shougaisha hoken fukushi techou (精神障害者保健福祉手帳), you can submit both applications at the same time and share the diagnostic form, which saves time and money.
When Your Child Turns 18: Continuing Medication into Adulthood
If your child takes medication through childhood and adolescence, they will likely need to continue into adulthood. Here is what changes:
The doctor may change. Child psychiatrists and pediatric neurologists typically see patients up to age 15 or 18, depending on the clinic. After that, your child will need to transition to an adult psychiatrist (seishin ka i / 精神科医) or a general mental health clinic. Ask your child's current doctor to recommend an adult provider and write a referral letter well before the transition.
The prescriptions continue. ADHD medications like Strattera and Intuniv are approved for both children and adults in Japan. Concerta is also approved for adult use. Your child's medication can continue without interruption as long as they have a prescribing doctor.
The jiritsu shien iryou program continues. The seishin tsuuin iryou (精神通院医療) category covers adults as well as children. Your child can continue receiving the reduced medical costs into adulthood. You will need to update the designated provider if the doctor changes.
Insurance changes. When your child turns 18 or starts working, their health insurance situation may change (from being covered under your plan to having their own). Make sure there is no gap in insurance coverage during the transition.
Start planning the transition at least a year before your child's current specialist will stop seeing them. The last thing you want is a gap in care where your child has no doctor and cannot get their medication refilled.
Practical Tips
- Get the referral letter first. Before you try to book an appointment with a specialist, ask your pediatrician for a referral letter. It will make the process smoother and may be required.
- Call early. Wait times for child psychiatry and pediatric neurology can be months. Call as soon as you think your child might need a specialist, not when you are certain. You can always cancel if you do not need it.
- Ask about Concerta registration. If ADHD medication is a possibility, confirm that the doctor you are booking with is a registered prescriber before you wait months for an appointment.
- Bring the okusuri techou to every visit. The medication handbook is important for both the doctor and the pharmacist. If you do not have one, the pharmacy will give you one for free.
- Apply for jiritsu shien iryou early. The cost reduction applies from the date of application, so the sooner you apply, the sooner you start saving. Ask about it at the welfare desk.
- Medication is one part of the picture. Doctors in Japan typically recommend medication alongside therapy, environmental adjustments, and support at school or home. It is not a standalone solution.
- Ask questions. If your doctor recommends medication and you are not sure about it, ask them to explain why they recommend it, what the expected benefits are, what the side effects might be, and how long they expect your child to take it. You have the right to understand what your child is being prescribed.
- Plan the transition to adult care early. Start asking your child's doctor about the handover to an adult provider at least a year in advance.
Key Terms
| Japanese Term | English |
| 児童精神科 (jidou seishin ka) | Child psychiatry |
| 小児神経科 (shouni shinkeika) | Pediatric neurology |
| 発達外来 (hattatsu gairai) | Developmental outpatient clinic |
| 紹介状 (shoukai jou) | Referral letter (from your pediatrician) |
| 処方箋 (shohousen) | Prescription |
| 調剤薬局 (chouji yakkyoku) | Dispensing pharmacy |
| お薬手帳 (okusuri techou) | Medication handbook |
| 登録医 (touroku i) | Registered prescribing doctor (for Concerta/Vyvanse) |
| ADHD適正流通管理システム (ADHD tekisei ryuutsuu kanri shisutemu) | ADHD Proper Distribution Management System |
| コンサータ (konsaata) | Concerta (methylphenidate, requires registration) |
| ストラテラ (sutoratera) | Strattera (atomoxetine) |
| インチュニブ (inchiunibu) | Intuniv (guanfacine) |
| ビバンセ (bibanse) | Vyvanse (lisdexamfetamine, children, requires registration) |
| リスパダール (risuperdaaru) | Risperdal (risperidone, for ASD irritability ages 5-17) |
| エビリファイ (ebirifai) | Abilify (aripiprazole, for ASD irritability ages 6-17) |
| 精神科医 (seishin ka i) | Psychiatrist (adult) |
| 自立支援医療 (jiritsu shien iryou) | Self-support medical care (cost reduction program) |
Useful Resources
Finding a Specialist
MHLW: Medical Information Net (search hospitals by specialty and area) https://www.iryou.teikyouseido.mhlw.go.jp/znk-web/juminkanja/S2300/initialize
Japan Society of Child Neurology: Specialist Directory (小児神経専門医のいる施設) https://www.childneuro.jp/general/6462/
Hattatsu Shougai Jouhou Navi Portal (finding support centers by prefecture) https://hattatsu.go.jp/
Medication Information
National Rehabilitation Center: Approved Medications for Developmental Disabilities (発達障害に関する医薬品情報) https://www.rehab.go.jp/ddis/howto/consult/drug/
PMDA: English Drug Review Portal (approved drug information) https://www.pmda.go.jp/english/review-services/reviews/approved-information/drugs/0001.html
PMDA: Risperdal Approval Document (リスパダール, PDF) https://www.pmda.go.jp/files/000220043.pdf
MHLW: Concerta Distribution Management (コンサータ適正流通管理) https://www.mhlw.go.jp/web/t_doc?dataId=00tb7615&dataType=1&pageNo=1
ADHD Medications in Japan (peer-reviewed) https://pmc.ncbi.nlm.nih.gov/articles/PMC8411317/ https://doi.org/10.1371/journal.pone.0252420
Medications for ASD in Japan (peer-reviewed) https://doi.org/10.1186/s12888-021-03201-6
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