한국 발달장애 아동·청소년 정신건강요구 선별척도(KMS-CDD) 개발 및 타당화 = Development and Validation of Korea Mental Health Needs Screening Scale for Children with Developmental Disabilities(KMS-CDD)

다국어 초록 (Multilingual Abstract)

The purposes of this study are to develop the KMS-CDD and to determine whether it is a reliable and valid measure. The survey was developed based on a thorough review of the literature and a series of feedbacks via focus group interviews (FGIs) from different groups (parents, teachers, psychiatrist). A cross-sectional study of children and adolescents aged 7-20 years was utilized. The data were collected from within 40 special schools from different levels (elementary, middle, and high schools) across the nation. The sample included a total of 1,352, which represent male (n=867, 64.1%), autistic spectrum disorder (n=416, 30.8%), and intellectual disabilities (n=908, 67.1%). Confirmatory factor analysis (CFA) was utilized in order to assess the psychometric properties of the developed scale. Descriptive statistics were analyzed by SPSS 23.0 and CFA was done by Mplus 7.2. FIML was employed to handle missing data. The CFA results indicated an overall acceptable fit of the model. The final model for the four factors showed fit indices with χ2(507) = 3324.898, p < 0.001, CFI = 0.826, TLI = 0.807, RMSEA = 0.064 (90% CI: 0.062-0.066), SRMR = 0.068.
The findings from this study suggest that the KMS-CDD represents a viable measurement tool for screening the mental health needs for children with developmental disabilities (intellectual disabilities and autistic spectrum disorder, etc.). No other scale has attempted to measure the mental health needs for children with developmental disabilities in Korea. The KMS-CDD may provide more options for teachers and psychiatrists who are seeking a screening tool for children with mental health needs in schools and communities. So far, the issue of comorbidity has not yet been studied as needed in Korea, especially in the part of the population that has cognitive limitations. The development and validation of this first screening scale for dual diagnosis, in the individuals with developmental disabilities, will help pave the way for early identification and further ongoing treatment for those who have both developmental disabilities and mental health needs.

국문 초록 (Abstract)

본 연구의 목적은 국내 발달장애 아동·청소년의 정신건강 요구(mental health needs)를 측정하는 선별척도를 개발하는 것이다. 전 세계적으로 발달장애인의 정신건강 문제에 대한 전문적 개입요구가 확대됨에 따라 잠재적 ‘이중진단’(dual diagnosis)에 대한 관심도 가중되고 있다. 이에 발달장애 아동·청소년의 정신건강 요구를 조기에 선별할 수 있는 측정도구의 개발과 타당화 연구의 필요성이 제기되었다. 본 연구에서는 전국 40개 특수학교에 재직 중인 1,352명의 특수교사를 대상으로 이들이 담당하고 있는 발달장애 아동·청소년에 대한 자료를 수집하였다. 관련 문헌연구와 전문가 협의회를 거쳐 54개의 문항 초안을 개발하고 이에 대한 기술통계분석과 이론적 내용분석을 실시하여 4개 하위요인, 총 34개 문항으로 구성된 예비도구를 제작하였다. 이 4개 요인 34개 문항을 활용하여 확인적 요인분석을 통해 최종모델 도출과 하위요인별 구성개념 타당도를 확인하였다. 확인적 요인분석 결과, 최종 모형이 χ²(507)= 3924.899(p<.001), CFI=.826, TLI=.807, RMSEA=.068, SRMR=.068 등으로 비교적 양호한 적합도 값을 보이는 것으로 나타났다. 또한 신뢰도 수준은 4개 하위영역 Cronbach’s α값이 .686에서 .805까지로, 그리고 전체 문항의 신뢰도는 .899로 이 역시 양호한 것으로 나타났다. 이렇게 개발된 척도는 ‘한국 발달장애 아동·청소년 정신건강요구 선별척도’(Korea Mental Health Needs Screening Scale for Children with Developmental Disabilities, KMS-CDD)로 명명하였다. 학령기 전체 연령의 발달장애 아동·청소년에게 사용 가능한 이 척도 개발의 의의와 임상적 적용시 유의사항, 그리고 본 연구의 제한점과 후속연구와 현장을 위한 제언을 제공하였다.

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