품행장애와 적대적 반항장애의 발달 경로 탐색

문장원(Moon, Jang-Won),마소(Ma, Xiao) 한독심리운동학회 2021 심리운동연구 Vol.7 No.1

적대적 반항장애는 종종 품행장애 발달의 초기 단계를 형성하는 경미한 형태의 품행장애로 여겨져 왔다. 그러나 두 장애 사이의 연관성에 대한 현재 증거는 상당히 제한적이며 발달적 관계에 대한 혼합된 지원만 제공하며, 적대적 반항장애는 여전히 논란의 여지가 있는 진단이기도 하다. 품행장애와 적대적 반항장애 사이의 연관성은 적대적 반항장애 증상 내에서 명확한 차원을 확인함으로써 명확해질 수 있다. 이 연구는 품행장애와 적대적 반항장애에 대한 관련 연구들을 통해 밝혀진 내용들을 기초로, 적대적 반항장애에서 품행장애로 진행되는데 관여하는 예측 인자에 대해 탐색하고, 품행장애와 적대적 반항장애의 발달 경로를 검토한 후, 품행 문제의 발현 시기와 품행장애의 위험 요인에 대해 알아보고자 하였다. 연구 결과, 적대적 반항장애는 품행장애의 전조증상이며, 적대적 반항장애가 품행장애로 진행되는데 관여하는 요인들은 여러 가지가 있는데, 진행 과정에서 어떻게 그 요인들을 관리하느냐가 품행장애로 진행되는데 많은 영향을 미치는 것으로 판단된다. Oppositional defiant disorder has often been regarded as a mild form of conduct disorder that forms the early stages of the development of behavior disorder. However, current evidence for the link between the two disorders is quite limited and provides only mixed support for developmental relationships, and oppositional defiant disorder is still a controversial diagnosis. The link between behavioral disorder and oppositional defiant disorder can be clarified by identifying clear dimensions within the symptoms of oppositional defiant disorder. This study explores the predictors involved in the progression from oppositional defiant disorder to conduct disorder, based on the findings from related studies on conduct disorder and oppositional defiant disorder, and examines the development path of conduct disorder and oppositional defiant disorder. After that, we tried to find out the timing of onset of conduct problems and risk factors for conduct disorders. As a result of the study, oppositional defiant disorder is a precursor of conduct disorder, and there are several factors that are involved in the progression of oppositional defiant disorder to conduct disorder, and it is judged that how to manage the factors in the process of progression has a great influence on the progression of conduct disorder.

산책활동이 발달장애 유아의 경험에 주는 의미

강승희,황순영,김봉희 한국지체.중복.건강장애교육학회 2008 지체.중복.건강장애연구 Vol.51 No.2

This study is to analyze and understand the experience world formed through walking activities in young children with developmental disorder. For this study, the researcher chose participant observation as a method of qualitative research and collected materials related to the theme. According to the research questions formulated for understanding the experience world of young children with developmental disorder, the meanings of their experience world are as follows. First, with regard to the questions of how the personal-level experience world formed through walking in young children experienced nature from outside to inside through immediate contact. This process was strengthened through inquisitive activities and plays, through which the children experienced natural objects and facilities around intimately. That is, through the channel of walking, the young children expressed their inside to outside and formed concepts from outside to inside. Second, with regard to the questions of how the social-level experience world formed through walking in young children with developmental disorder, they observed people in various communities and came to have understanding and positive perception of their social roles. In addition, they acquired social norms such as the control of behavior demanded in social places, and learned adequate interaction methods. Besides, the formation of peer relation was found meaningful. Through walking activities, closer peer relation was formed between children with disorder and those without. The peer relation was strengthened through the process of helping and supporting one another in various situations of outdoor environment. In particular, conflicts among peers appeared not to have a significant effect on the maintenance of peer relation. In addition, the young children with developmental disorder acquired social norms demanded in each social place and learned how to interact properly through imitation. The results of this study show that the walking activity program is useful in strengthening personal-level and social-level experiences in young children with developmental disorder and changing them dynamically. 본 연구에서는 발달장애 유아들의 산책 활동을 통해 형성되는 이들의 경험 세계를 이해하고 분석하고자 하였다. 발달장애 유아 4명이 산책활동을 경험하고 이를 통해 얻어지는 경험들이 유아의 개인적-사회적 발달에 주는 의미를 해석하였다. 이에 발달장애유아들은 산책활동을 통해 자신의 내면에 잠재되어 있는 움직임과 감정을 역동적으로 발산해 냈고, 이 과정은 유아들의 탐색과 놀이를 통해 심화되었으며, 탐색과 놀이를 통해 발달장애 유아들은 자연물과 주변의 시설물을 친숙하게 경험하는 개인적인 성숙의 기회들을 가졌다. 그리고 발달장애유아들은 지역사회의 사람들과 또래들의 모습을 관찰하고, 그들의 사회적 역할에 대한 이해와 긍정적인 인식을 갖는 동시에, 사회적 장소에 따라 요구되는 행동의 조절과 같은 사회적 규범을 터득하여 사회적 관계를 형성하는데 필요한 상호작용 방식을 배우게 되었다. 이러한 연구결과를 통하여 산책활동은 발달장애 유아들의 개인적, 사회적 차원의 경험을 강화시키고 유아의 발달을 역동적으로 변화시키는데 유용한 프로그램임을 알 수 있으며, 장애를 가지고 있는 유아들에게 물리적인 접근의 어려움을 극복할 수 있는 교육적 실천행위로서 산책활동이 유용함을 시사한다.

자폐적 장애 및 발달적 언어장애 환아에서 자기공명영상을 이용한 뇌량, 시상, 소뇌 및 뇌교에 대한 구조적 예비연구

이정섭,강민희,홍강의 대한신경정신의학회 1999 신경정신의학 Vol.38 No.1

연구목적 : 자폐적 장애가 있는 환아에서 뇌량, 시상, 소뇌 및 뇌교에 대한 구조적인 연구가 시행이 되었으나, 아직까지 일관된 결과는 나오지 않고 있다. 또한 발달적 언어 장애가 자폐적 장애와 연관이 있다는 가설도 있으나 아직까지 체계적으로 연구된 바 없다. 본 연구에서는 개량된 방법론을 이용하여 자폐적 장애에서 뇌량, 시상, 소뇌 및 뇌교에 대한 정량적인 측정을 하고, 자폐적 장애와 발달적 언어장애가 뇌의 구조적으로 연관이 있는 가를 연구하였다. 방 법 : 진단기준은 DSM-Ⅲ-R로 하였으며, 후향적인 연구를 통하여 8명 자폐적 장애와 8명의 발달적 언어장애를 선정하였으며 모두 남아로 하였다. 정상 대조군은 10명의 남아를 선정하였다. 자기공명영상은 정중시상영상에서 NIH image를 이용하여 뇌량, 시상, 소뇌 및 뇌교의 면적을 측정하였다. 뇌량은 Witeleson의 방법에 따라서 7개의 구역으로 나누어서 측정하였으며, 소뇌는 다시 충부소엽에서 Ⅰ - Ⅴ, Ⅵ - Ⅶ, Ⅷ - Ⅹ의 3개의 구역으로 나누어서 비교하였다. 결 과 : 자폐적 장애군에서 뇌량의 문(rostrum)부가 대조군이나 발달적 언어장애군에 비하여 유의하게 적었으며(F=3.93, d.f.=2.23.25, p=0.03. scheffe의 사후검증에서는 p=0,06이 나왔다. 시상, 뇌교, 소뇌에서는 차이가 없었다. 발달적 언어장애에서는 시상이 대조군에 비하여 유의하게 크다고(t=2.21, d.f.=16, p=0.04) 나왔으며, 뇌량, 뇌교, 소뇌에서는 차이가 없었다. 결 론 : 본 연구에서는 자폐적 장애에서 뇌량의 문부가 대조군보다 감소되어 있는 소견을 발견하였으며, 후두와나 시상은 대조군에 비하여 차이가 없었다. 이는 자폐적 장애가 신경발달학적인 이상이 더 많고 전 전두엽(prefrontal area)에 장애가 있을 가능성을 시사하여 준다. 자폐적 장애와 발달적 언어 장애 간의 뇌의 구조적인 연관성은 발견되지 않았다. Objective : This study aimed to planimetrically measure the corpus callosum, cerebellum, pons and thalamus in the boys with autistic disorder and developmental language disorder. Method : The midsagittal brain MR images of 8 autistic and 8 developmental language disorder subjects who met the DSM-Ⅲ-R diagnostic criteria and 10 comparison subjects were collected. MR image were recapitalized with flatbed scanner and the data were analyzed with NIH IMAGE 1.61 software. Pixel counting and area measurements were done. The corpus callosum was divided into seven regions and the cerebellar vermis was divided into three regions. Results : In autistic subjects, the rostrum of corpus callosum was found to have significantly smaller area than comparison and developmental language disorder subjects. In developmental language disorder subjects, the thalamus was significantly larger than comparison subjects. the cerebellar vermis and pons did not differ among three groups. Conclusion : The rostrum of the corpus callosum in autistic disorder was significantly smaller. This finding supports the theory of abnormal prefrontal lobe development in autistic disorder.

Clinical Usefulness of the Korean Developmental Screening Test (K-DST) for Developmental Delays

Chul Hoon Jang,Seong Woo Kim,Ha Ra Jeon,Da Wa Jung,Han Eol Cho,Jiyong Kim,Jang Woo Lee 대한재활의학회 2019 Annals of Rehabilitation Medicine Vol.43 No.4

Objective To evaluate the clinical usefulness of the Korean Developmental Screening Test (K-DST) via comparison with Korean Ages and Stages Questionnaire (K-ASQ) for the diagnosis of developmental delay in pediatric patients. Methods The K-DST and K-ASQ were used to screen pediatric patients who visited the hospital for evaluation and diagnosis of delayed development. Korean Bayley Scales of Infant Development-II (K-BSID-II) or Korean Wechsler Preschool and Primary Scale of Intelligence III (K-WPPSI-III) were used for the standardized assessment. Moreover, the final clinical diagnosis was confirmed by three expert physicians (rehabilitation doctor, psychiatrist, and neurologist). The sensitivity and specificity of each screening tool for the final diagnosis were investigated and correlated with standardized assessments. Results A total of 145 pediatric consultations were conducted, which included 123 developmental disorders (40 autism spectrum disorders, 46 global developmental delay/intellectual disability, and 37 developmental language disorders) and another 22 that were not associated with any such disorders. The sensitivity and specificity of K-DST based on the final clinical diagnosis were 82.9% and 90.9%, respectively, which were not significantly different from that of K-ASQ (83.7% and 77.3%). Both K-DST and K-ASQ showed good correlation with K-BSID-II and K-WPPSI-III. No significant difference was found between the K-DST and K-ASQ measures. Conclusion K-DST is an excellent screening tool and is expected to replace K-ASQ with high validity.

발달장애유아의 그림발달단계 선호 색채 사용 색채 수 분석

이규순 한국예술심리치료학회 2009 예술심리치료연구 Vol.5 No.2

The Purpose of this study was to analysis of development-disorder infant's drawing focusing on their drawing's developmental stages, preferred colors, and number of color. First, with regard to stages of development in drawings based on sex and age, I came to know that most infants with development disorders are in the scribing stage, which is the first stage of the 6 stages on development in drawings that V. Lowenfeld crafted for infants. And, it was also found that female infants are relatively in higher stages than their male counterparts in terms of development in drawings. Along with this, though individual differences in the development are stark based on the severity of disorders, infants with development disorders also show progress in drawings as they grow older, and I could see that to some extent, they are able to express their emotions more freely. Second, I studied whether colors they like are different according to sex and age. I found out that male infants with development disorders prefer a black color the most, and female infants like a green color the most, showing that male and female infants with development disorders have different color preferences. In addition, it turned out that those who are at 4 like orange, reddish brown and black colors the most, and infants of 5 years old prefer a yellow color the most. Many people have conducted research on color preferences, and they are showing much different views on this matter. Third, regarding whether there are differences in the number of colors they use according to sex and age, a lot of male infants drew pictures using one color, and in the case of female infants, many of them used two kinds of colors. For infants with development disorders, I could see that the number of colors they used according to sex has statistical importance. Infants with development disorders of 4 years old turned out to use two colors when they draw pictures, and in the case of those who are at 5, many of them used one color. For infants with development disorders, the number of colors they use based on age has no statistical importance.

발달장애아 어머니 양육체험의 교육적 가능성

신현정 한국자폐학회 2015 자폐성 장애연구 Vol.15 No.1

본 연구의 목적은 발달장애아 어머니의 양육체험에서 교육적 가능성을 발견하는 데 있다. 이를 위해 2012년 5월부터 2014년 10월까지 약 29개월의 연구기간 동안 참여관찰과 심층면담을 수행하였다. 발달장애아 어머니 양육체험 맥락에 대해 현상학적 내러티브의 방법을 활용하여 살펴보았고 이를 바탕으로 교육적 가능성을 탐색할 수 있었다. 발달장애아 어머니의 양육체험에는 ‘낙인’, ‘각인’, ‘역능’이라는 생활 모습이 있었다. 그런데 발달장애아를 키운다고 낙인찍힌 어머니의 삶은, 역능에 의해 긍정적 각인과 부정적 각인의 방향으로 나뉘어졌다. 그 역능은 교육적 가능성과 관련되었다. 발달장애아 어머니의 교육적 가능성은 개인 내, 개인 간 상황적 모습이자 노력의 방향이기도 했다. 교육적 가능성은 다음과 같이 드러났다. 첫째, 발달장애아 어머니는 양육체험으로 몸을 통한 학습을 할 수 있었고 둘째, 자신을 감추는 은폐와 자신을 드러내는 현상 ‘사이’에서 자신 삶의 방향을 정했다. 셋째, 다양성의 인정과 지향을 통해 더 이상 자신을 세상의 일반화된 눈으로 보지 않으려 했다. 이는 개인 간에 이루어져야 하는 교육적 가능성의 모습이기도 하다. 넷째, 공동체를 통해 더 나은 삶을 모색하려는 어머니의 시도는 또한 우리 사회가 간과하지 말아야 할 개인 간 노력의 구체적 실현이기도 하다. This research aimed at revealing educational possibilities on nurturing of developmental disorder children's mothers in daily life. For this purpose, interview with them and participant observation were conducted during 29 months. The results of nurturing context and educational possibilities on developmental disorder’s children were revealed by based on a way of phenomenological narrative method as a deeper understanding about mothers with developmental disorder children. Mothers with developmental disorder children had experienced ‘stigma’, ‘engraving’, ‘power’. Especially, the ‘engraving’ had splitted into between positive things and negative things. Positive engraving was related to ‘power’. ‘Power’ was also connected to educational possibilities. Educational possibilities had four aspects as below. First, mothers themselves had experienced nurturing their children vividly by their own lived body. Second, they had tried to set direction by looking into ‘inter’ between ‘concealing’ and ‘revealing(phenomenon)’. Third, they had tried not to see themselves as a generalized sight through approval and intention of diversity. Forth, Seeking community for better life of their own was also a good concrete way to go together with us in order to live happily life. Society also should be responsible for community for all.

발달성 언어장애아의 임상적 고찰

김수진(Soo Jin Kim),김영훈(Young Hoon kim),이윤경(Yoon Kyung Lee),김동언(Dong Un Kim),한승훈(Seung Hoon Han),정승연(Seung Yun Chung),이인구(In Goo Lee),이익준(Ik Jun Lee),황경태(Kyung Tai Whang) 대한소아신경학회 2001 대한소아신경학회지 Vol.9 No.1

목적: 발달성 언어장애는 기질적인 요인 없이 언어발달에만 지연을 초래하는 질환으로 형에 따라 아무런 조치를 취하지 않아도 자연적으로 언어발달이 정상적으로 이루어지는 경우가 많으나 언어 지연이 학령기 연령까지 지속되는 경우에는 행동장애와 학습장애를 비롯하여 여러 가지 이차적 문제를 일으키기 때문에 조기발견과 치료를 위하여 소아과 의사가 지속적으로 관심을 가져야 한다. 본 연구는 언어 지연을 주소로 소아과 외래에 내원한 환아 중 정신지체, 청력장애, 유아자폐증, 구음장애 등의 기질적인 이상 없이 언어발달이 지연된 소아를 대상을 소아의 성별과 연령의 분포, 의미 있는 단어 출현의 시기 및 예후를 알아보고자 하였다. 방법: 1993년 3월부터 1997년 6월까지 가톨릭 의대 강남성모병원 소아발달 클리닉에 언어지체를 주소로 발달 및 언어검사를 받았던 171명의 소아 중 기질적 요인이 없는 발달성 언어장애를 보여 6개월 간에 추적관찰이 가능하였던 75명(남아 65명, 여아 10명)을 대상으로 하였다. 결과: 1) 대상환아 75명 중 남아가 86.7%, 여아가 13.3%로 남녀 비는 6.5:1이었으며 평균연령은 31.4개월로 24개월-35개월이 60%를 차지하였다. 2) 평균재태기간은 38.8주로 만삭아는 82.7%, 미숙아 17.3%이였다. 3) 가족력상 첫째는 82.7%, 둘째는 13.3%, 셋째는 4% 이었다. 4) 뇌 자기공명검사는 총 10명에서 시행하였는데 4명에서 이상소견을 보였으며 뇌파검사는 총 23명에서 시행하였는데 2명에서 이상소견을 보였다. 5) 의미있는 첫 단어의 평균 출현시기는 13.8개월 이었다. 6) Gesell 발달 검사상 각 영역 DQ가 70 미만인 환아는 운동영역 4%, 적응영역 17.3%, 언어영역 66.7%, 개인성 사회성영역 33.3%이었다. 7) REEL 언어 검사상 각 영역 DQ가 70 미만인 환아는 수용언어영역 70.7%, 표현언어영역 90.7%이었다. 8) 6개월 후에 추적 검사한 결과는 지속적인 언어지연을 보인 환아는 17.3%이었으며 정상적인 언어발달을 보인 환아는 82.7%이었다. 결론: 이상의 결과로 언어지연을 주소로 내원한 환아의 많은 수가 기질적 요인이 없는 발달성 언어장애였으며, 이중 대부분이 6개월에 시행한 추적검사에서 언어발달의 향상을 보였음을 알 수 있었다. Purpose: Children with developmental language disorder occupy considerable health care resources, particularly in the preschool ages. The exact size of problem for health planning remains somewhat problematic, as differences in reported estimates of prevalencies reflect the range of definitions used. In this study, we evaluated the clinical features of children with developmental language disorder and examined effctiveness of the Gesell Screening inventory and REEL scale to assess language development. Methods: The 171 children were involved in the study, they were referred to Child Development Clinic in Kangnam St. Mary's Hospital for evaluation of suspected language problem. Among the children, 75 cases between 15 and 54 months of age were included as developmental language disorder in this study. Results: 1) The mean age of subjects was 31.4 months and ratio of male to female was 6.5:1. 2) The mean gestational age of the subjects was 38.8 weeks. The proportion of full-term infants was 82.7% and the one of premature infants was 17.3%. 3) According to the birth ordering history, the proportion of the first baby was 82.7%, the one of second baby was 13.3% and the one of third baby was 4%. 4) Ten children had been checked up the MRI, four of them had abnormal findings, 23 children had been checked up the EEG and two of them showed abnormal findings. 5) The mean age of first spontaneous word with used meaning was 13.8 months. 6) According to the Gesell Screening Inventory, the proportion of children who had less than DQ 70 had showed 4% in motor sector, 17% in adaptive sector, 66.7% in language sector and 33.3% in personal social sector. 7) according to the REEL Scale, the proportion of children who had less DQ 70 had showed 70.7% of in receptive language sector and 90.7% in expressive language sector. 8) The proportion of the children who had been maintaining language disorder was 17.3% and that of those who showed normal linguistic development was 82.7% on the follow-up test 6 months later. Conclusion: The large proportion of the children who had language delay was developmental language disorder without organic problem. Most of them showed symptom improvement on the follow up test 6 months later.

일본에서 발달장애아를 대상으로 Kampo치료 및 교육프로그램의 제공에 대한 연구동향

김미숙,고병섭 대한한방소아과학회 2019 대한한방소아과학회지 Vol.33 No.4

Objectives: This study reviewed the effects of a combined treatment with Kampo and Western medicine for Developmental disability in Japan, and the provision of education programs in clinical care. Methods: The search database includes J-STAGE. To narrow the search, the following key words were used: 'pervasive developmental disorders, Attention-Deficit/Hyperactivity Disorder, Learning Disorders or Learning Disabilities, Intellectual Disability, and Kampo'. The search was limited to the publication date from 2001 to 2019. Results: Japan analyzed five sections: The usage of the Kampo medicine ranges from 25.2% to 71.6%, and the Kampo medicine was highly used in large cities. 2. In Japan, the educational programs were provided for the caregiver and special educational programs were available for children with disabilities. 3. In Japan, there were 9 studies regarding developmental disability treating with herbal remedies. There were seven clinical trial reports, and two were published in a review or report form. 4. The results showed benefits of using Kampo for patients with lack of Yin in blood in treatment of developmental disorder. It is also important to control the liver qi and Yin in blood. 5. Seven papers reported no side effects or abnormal findings. They have reduced the use of antipsychotics. Conclusions: These review studies in regards to the combined treatment of Kampo and Western medicines can be helpful to improve long term side effects of the antipsychotics used in developmental disorders.

공황장애의 평가

김정범 대한생물치료정신의학회 2000 생물치료정신의학 Vol.6 No.2

The four general areas to be evaluated in cases of panic disorder are (1) medical status, (2) phenomenology and history of panic auld agoraphobia, (3) comorbidity and history of other psychiatric disorders, and (4) predisposing and precipitating factors for panic attacks and factors maintaining the panic disorder. The assessment also involves information about how panic-disordered individuals behave on the five major response systems and their interaction: cognitive, behavioral, affective, physiological, and social. In order to tap into these different areas and response systems, clinicians should use a variety of measurement techniques: clinical interviews, self-report scales, self-monitoring, behavioral observation, psychophysiological monitoring. The use of a simple, psychometrically sound instrument such as Panic Disorder Severity Scale(PDSS), which considers all of the essential domains of panic disorder, will provide clinicians with an appropriate measure for diagnosing and monitoring patients. The application of this more comprehensive scale for monitoring patient should alert clinicians to reemergence of associated symptoms of panic disorder and allow for the rapid modification of treatment. All of the investigators who conduct any study of panic disorder should consider the essential, recommended, optional measures agreed in Consensus Development Conference on the treatment of panic disorder in 1992 and implement them in their research. Then the results of study from different laboratories will be easier to compare.

발달장애아동의 운동평가(2000-2020년)에 대한 국내 연구 동향 고찰

남수미(Soo-Mi Nam),정진욱(Jin-Wook Chung),김민주(Min-Joo Kim) 한국발육발달학회 2021 한국발육발달학회지 Vol.29 No.3

This current study was aimed to summarize the domestic research on motor assessments for children with developmental disorder and examine how these assessment tools were used in previous research. A total of 54 articles published from January 2000 to January 2020 were investigated based on the criteria of analysis. We found that the most literature investigated the effect of intervention using motor assessment tools besides correlation research or cross-sectional study. Secondly, children with cerebral palsy participated in the study the most and then there were intellectual disorder, autism spectrum disorder, down syndrome, developmental coordination disorder, developmental delay, and attention deficit hyperactivity disorder in order of number. Thirdly, the motor assessment tools adopted in previous studies were divided into two domains : motor development and physical fitness. Among them, the most frequently used were Gross Motor Function Measurement, Test of Gross Motor Development-second Edition, Pediatric Balance Scale and others. In the future, research on verification of validity and reliability of motor assessment tools and application of ICT will be needed. These future research will be required to quantify a movement of children with developmental disorder and classify these movements.