Is School Refusal Really 'May Sickness'? Over 50% of Children Report Morning Sluggishness Post-Golden Week

It has been a month since the new school term started following the Golden Week (GW) holidays. An increasing number of families are struggling as their children complain of symptoms like "inability to wake up in the morning" or "reluctance to go to school." These are not simply cases of "May sickness" (post-holiday blues) or "laziness," but could be masking "Orthostatic Dysregulation (OD)," an illness prone to develop during adolescence. The Association for Improvement of Orthostatic Dysregulation conducted a nationwide "Fact-finding Survey on Children's Morning Sluggishness and Orthostatic Dysregulation" targeting 200 parents of older elementary to high school students (aged 10-18). The results revealed that while over half of the children show some form of morning sluggishness, approximately 60% of parents do not understand the overview of OD, often viewing the initial signs as "disrupted lifestyle habits" or "smartphone overuse."

Survey Background
With about a month passing since the start of the new term, May, immediately following GW, is a time when the tension in children breaks, and mental and physical discomfort easily surfaces. Symptoms such as "inability to wake up" and "headaches or dizziness" are commonly confused with "May sickness," "laziness," or "staying up late." However, these are also typical symptoms of "Orthostatic Dysregulation (OD)" caused by autonomic nervous system dysfunction. In fact, due to a lack of understanding from parents, strictly scolding the child or forcing them to attend school can worsen the symptoms and lead to school refusal in many cases. Therefore, the association conducted this survey to clarify how parents perceive and respond to their children's unwellness, and to determine the level of awareness regarding OD.

Survey Summary
- Changes post-GW: 57.0% of parents reported that their children had difficulty waking up or showed reluctance to go to school.
- Specific symptoms: The top issue was "inability to wake up/get out of bed (26.5%)," followed by "sluggishness/fatigue (14.6%)."
- Awareness challenge: Regarding OD, about 60% (58.5%) of parents have heard the name but "do not know the details."
- Initial perception: While about 40% suspected "disrupted lifestyle during GW" or "late nights/smartphones," only 3.0% suspected a "possibility of illness."
- Current response: The most common daily care is "encouraging improvement of lifestyle rhythm." Meanwhile, some families are "groping in the dark," not knowing how to respond.

Detailed Data
Q1: Since the end of GW, has your child shown signs of "not being able to wake up" or "not wanting to go to school"?
- Occasionally: 25.5%
- A few times: 25.0%
- Rarely: 22.5%
- Not at all: 20.5%
- Frequently: 6.5%
-> Combining "frequently," "occasionally," and "a few times" reaches 57.0%, indicating that in over half of the households, children showed some abnormalities or school refusal post-GW. This suggests it is a period when fatigue from a new environment tends to surface at once.

Q2: What specific morning symptoms have you observed in your child?
- Inability to wake up/get out of bed: 26.5%
- No particular symptoms observed: 23.5%
- Complains of sluggishness and fatigue: 14.6%
- Less appetite than usual: 7.6%
- Irritable/anxious: 7.0%
- Other: 20.8% (lack of concentration: 6.6%, headaches: 3.6%, dizziness when standing: 3.3%, etc.)
-> Following "inability to wake up," symptoms overlapping with OD's main symptoms, such as "sluggishness/fatigue," are frequently cited. Since these are strong in the morning and often improve by the afternoon, they are easily misunderstood by others as "skipping" or "an attitude problem."

Q3: How much do you know about the illness "Orthostatic Dysregulation (OD)"?
- Have heard the name: 35.5%
- Know the name and overview: 33.5%
- Know nothing at all: 11.5%
- Know very little: 11.5%
- Know in detail (symptoms/treatments): 8.0%
-> Those who only know the name or lack detailed knowledge (name only, very little, nothing at all) account for 58.5%, roughly 60%. Although awareness of the disease name is spreading, understanding of specific symptoms and appropriate coping methods remains insufficient.

Q4: When you saw your child unable to wake up or reluctant to go to school, what did you initially feel?
- No morning sluggishness or school refusal: 28.0%
- Felt it was due to disrupted lifestyle during GW: 22.0%
- Felt it was due to late nights/smartphones: 17.0%
- Worried something happened at school: 7.0%
- Thought it might be May sickness: 7.0%
- Other: 19.0% (felt they were being lazy: 6.0%, thought it was typical of adolescence: 4.5%, suspected an illness: 3.0%, etc.)
-> Over 40% of parents view these changes as caused by the child's lack of self-management or temporary mental state (May sickness), such as "lifestyle disruption" or "smartphones/laziness." Conversely, only 3.0% suspected an illness, indicating a risk of overlooking the disease in its early stages.

Q5: How are you currently responding to your child's morning sluggishness or school refusal?
- Encouraging improvement of lifestyle rhythm (bedtime, etc.): 20.3%
- No morning sluggishness or school refusal: 19.9%
- Increasing time to listen to their feelings: 13.3%
- Prioritizing physical condition, not forcing school: 12.3%
- Paying attention to diet, hydration, and salt intake: 7.6%
- Other: 26.6% (flexible attendance like arriving late: 6.3%, consulting and coordinating with school/teachers: 6.0%, coordinating with medical institutions: 4.7%, etc.)
-> The most common approach is "encouraging improvement of lifestyle rhythm," but since OD is caused by autonomic nervous system imbalances beyond the child's control, forcing a strict lifestyle can conversely corner the child. Some families are "strictly urging school attendance (3.2%)," highlighting the need for appropriate care based on correct knowledge.

Summary of Survey Results
This survey revealed that many parents face their children's symptoms like "unable to wake up" and "sluggishness" post-GW. However, most judge this to be caused by "disrupted lifestyle" or "smartphones/late nights," and very few parents consider the possibility of the hidden illness, Orthostatic Dysregulation (OD). The reality that about 60% of parents lack correct knowledge of OD suggests a risk of misunderstanding the symptoms as "laziness," leading to scolding or forced school attendance. Instead of dismissing children's "morning stumbles" as mere May sickness or mood issues, it is necessary to properly monitor them as signs of poor health and consult specialized institutions when necessary.

Comments from the Association for Improvement of Orthostatic Dysregulation
The new term post-GW is a period when children are released from the tension of their new environments, making it the most vulnerable time for autonomic nervous system imbalances. Inability to wake up in the morning...