4 - (SYM (9) Case Study of Cognitive Behavior Therapy for 15 Years of Hikikomori with Adult ADHD and ASD Including Welfare-based Employment Support and Support for Parents

Since the collapse of Japan’s economic bubble in the 1990s, job insecurity and declining birth rates have contributed to the phenomenon of "hikikomori" (social withdrawal) becoming a major social issue. In addition to these social factors, neurodevelopmental disorders such as ADHD and ASD, as well as comorbid conditions such as depression, anxiety disorders, and sleep disorders, are also contributing factors.

In this presentation, I will introduce a case study of an individual diagnosed with ADHD and ASD who experienced 15 years of hikikomori after graduating from university. Patient A secured a job through parental connections after graduating from university but resigned within two years. Then he remained hikikomori for 15 years. An intelligence test showed that his Full-Scale IQ was 105. However, his working memory and processing speed were significantly lower. Patient A stated, “I have tried several counseling sessions before, but none have worked. I want to talk about why I cannot manage my life successfully.” His diagnoses included ADHD, ASD, major depressive disorder, and generalized anxiety disorder, for which he was prescribed psychotropic medication. A notable characteristic of Patient A, associated with ASD, was his tendency toward rumination. He only engaged in actions when he could foresee a concrete outcome and felt confident about executing them successfully.

I addressed rumination by emphasizing values clarification and value-driven actions through Acceptance and Commitment Therapy. Specifically, we identified multiple values that Patient A considered important during his 15 years of hikikomori. By reassessing and prioritizing these values, we clarified his future goals in a visually structured manner.

Furthermore, I provided parental support using concepts from Community Reinforcement and Commitment Therapy (CRAFT) and Parent Child Interaction Therapy (PCIT) while facilitating value-driven actions and increasing outdoor activities. This was achieved through psychiatric day-care services, employment transition support, and disability employment programs, ultimately leading to the resolution of hikikomori in this case.

Declining birth rates are also progressing in advanced countries outside of Japan, including the United States, making hikikomori a potential future social issue globally. By presenting the details of this case, I hope to promote the dissemination of cognitive-behavioral therapy for hikikomori in advanced countries beyond Japan.