자폐스펙트럼장애와 지적 장애의 산과적 합병증 및 임상적 특성의 차이 = Differences of Obstetric Complications and Clinical Characteristics between Autism Spectrum Disorder and Intellectual Disability

국문 초록 (Abstract)

연구목적 자폐스펙트럼장애에 대한 인식이 높아지면서 진단을 위해 병원에 방문하는 영유아가 늘고 있고 조기 진단을 통한 조기 개입의 중요성이 부각되고 있다. 그러나, 자폐스펙트럼장애 환자가 처음 병원을 방문하게 되는 주 문제가 대부분 발달 지연이기 때문에 지적 장애와의 진단적 구별이 어렵다. 본 연구는 1) 자폐스펙트럼장애와 지적 장애 아동의 인구학적, 임상적 특성 및 산과적 합병증을 비교하고, 2) 초진 시 지적 장애로 진단을 받은 아동 중 재 방문 시 진단이 바뀐 아동과 진단이 유지된 아동의 특징을 비교하고자 한다. 방 법 2001년 5월부터 2014년 12월까지 국민건강보험 일산병원 발달지연클리닉에 내원한 아동 중 자폐스펙트럼 장애나 지적 장애로 진단된 816명의 아동을 대상으로 하였다. 부모 면담을 통해 인구학적, 산과적 합병증에 대해 조사하였다. 인지 평가를 위해 한국 베일리 영유아 발달검사와 한국 웩슬러 유아 지능검사를 시행했고 언어평가를 위해 영유아 언어 발달검사와 취학전 아동 수용언어 표현언어 발달척도I를 시행하였다. 1차 방문에서 자폐스펙트럼장애와 지적 장애로 진단된 아동의 특성을 비교하였고, 1차 방문 시 지적 장애로 진단된 아동 중 2차 방문 시 진단이 자폐스펙트럼장애로 바뀐 아동과 지적 장애로 유지된 아동의 특성을 분석 하였다. 결 과 1차 방문 시 자폐스펙트럼장애와 지적 장애로 진단 받은 아동을 비교한 결과 자폐스펙트럼장애에서 남아의 비율이 높고 산과적 합병증은 적었다. 또한, 자폐스펙트럼장애 아동이 지적 장애 아동에 비해 언어 평가상 전체 수행이 저조 하였고 특히 수용언어발달지수가 더욱 저조하였다. 1차 방문 시 지적 장애로 진단 받은 아동 중 2차 방문 시 진단이 자폐스펙트럼 장애로 바뀐 아동은 모두 남아였고, 지적 장애로 진단이 유지된 아동에 비해 발달 지연의 가족력(family history)이 많았다. 언어 평가 결과에서는 자폐스펙트럼 장애로 진단이 바뀐 아동에서 1차 내원 때 시행한 언어평가에서 수용언어지수가 더 낮은 점수를 보였다. 결 론 이러한 결과를 통해 성별, 언어평가 결과, 산과적 합병증 여부가 자폐스펙트럼장애의 조기 진단에 도움을 줄 수 있음을 알 수 있다.

다국어 초록 (Multilingual Abstract)

Objectives : Since the awareness of autism spectrum disorders(ASD) is growing, as a result, it is increasing numbers of infants and toddlers being referred to specialized clinics for a differential diagnosis and the importance of early autism spectrum disorders detection is emphasized. This study is to know the difference between ASD and intellectual disability(ID) from comparison of the demographics, clinical characters and obstetric complications. Methods : The participants are 816 toddlers who visited the developmental delay clinic(DDC) in National Health Insurance Ilsan hospital. The number of toddlers diagnosed as ASD and ID was 324 and 492. 75 toddlers out of 114 who returned to DDC were diagnosed as ID at the first visit but 7 of them had changed diagnosis to ASD at the second visit. After compared ASD with ID from the first visit, we analyzed characters of toddlers who had the changed diagnosis to ASD at the second visit. Results : As a result, the comparison between ASD and ID at the first visit shows that the boys have higher ratio, lower obstetric complication and lower language assessment score in ASD. The toddlers who had the changed diagnosis at the second visit were all boys and they had more cases of family history of developmental delay and had lower score of receptive language developmental quotient. Conclusions : These findings suggest that sex, language characteristics and obstetric complication could be useful in the early detection of ASD.

참고문헌 (Reference)

1 American Psychiatric Association, "Work Group to Revise DSM-5. Diagnostic and statistical manual of mental disorders:DSM-5-R" American Psychiatric Association 2013

2 Siegel DJ, "Wechsler IQ profiles in diagnosis of high-functioning autism" 26 : 389-406, 1996

3 Eaves LC, "The very early identification of autism : outcome to age 4 1/2-5" 34 : 367-378, 2007

4 Aicardi J, "The etiology of developmental delay" 5 : 15-20, 1998

5 Croen LA, "The epidemiology of mental retardation of unknown cause" 107 : E86-, 2001

6 Clifford SM, "The early development of joint attention in infants with autistic disorder using home video observations and parental interview" 38 : 791-805, 2008

7 Mandy W, "Sex differences in autism spectrum disorder : evidence from a large sample of children and adolescents" 42 : 1304-1313, 2012

8 Gustavson KH, "Severe mental retardation in a Swedish county. I. Epidemiology, gestational age, birth weight and associated CNS handicaps in children born 1959--70" 66 : 373-379, 1977

9 Hudry K, "Preschoolers with autism show greater impairment in receptive compared with expressive language abilities" 45 : 681-690, 2010

10 Juul-Dam N, "Prenatal, perinatal, and neonatal factors in autism, pervasive developmental disorder-not otherwise specified, and the general population" 107 : E63-, 2001

11 Burd L, "Prenatal and perinatal risk factors for autism" 27 : 441-450, 1999

12 Nelson KB, "Prenatal and perinatal factors in the etiology of autism" 87 (87): 761-766, 1991

13 Guinchat V, "Pre-, peri- and neonatal risk factors for autism" 91 : 287-300, 2012

14 Charman T, "Practitioner review : Diagnosis of autism spectrum disorder in 2-and 3-year-old children" 43 : 289-305, 2002

15 Chakrabarti S, "Pervasive developmental disorders in preschool children: confirmation of high prevalence" 162 : 1133-1141, 2005

16 Chakrabarti S, "Pervasive developmental disorders in preschool children" 285 : 3093-3099, 2001

17 Hultman CM, "Perinatal risk factors for infantile autism" 13 : 417-423, 2002

18 Asarnow RF, "Patterns of intellectual functioning in non-retarded autistic and schizophrenic children" 28 : 273-280, 1987

19 De Giacomo A, "Parental recognition of developmental abnormalities in autism" 7 : 131-136, 1998

20 Bolton PF, "Obstetric complications in autism: consequences or causes of the condition?" 36 : 272-281, 1997

21 Rumsey JM, "Neuropsychological divergence of high-level autism and severe dyslexia" 20 : 155-168, 1990

22 Kabra M, "Mental retardation" 70 : 153-158, 2003

23 Park H, "K-WPPSI: Korean wechsler preschool and primary scale of intelligence" Special Educational Pub 2002

24 Klin A, "Handbook fo infant, toddler, and preschool mental health assessment" Oxford 2004

25 Fujiwara T, "Factors influencing time lag between first parental concern and first visit to child psychiatric services in children with autism spectrum disorders in Japan" 5 : 584-591, 2011

26 Rodier PM, "Embryological origin for autism : developmental anomalies of the cranial nerve motor nuclei" 370 : 247-261, 1996

27 Osterling JA, "Early recognition of 1-year-old infants with autism spectrum disorder versus mental retardation" 14 : 239-251, 2002

28 Mitchell S, "Early language and communication development of infants later diagnosed with autism spectrum disorder" 27 : S69-S78, 2006

29 Maestro S, "Early behavioral development in autistic children : the first 2 years of life through home movies" 34 : 147-152, 2001

30 Aicardi J, "Diseases of the nervous system in childhood" Cambridge 1998

31 Maestro S, "Course of autism signs in the first year of life" 38 : 26-31, 2005

32 Kim YT, "Content and reliability analyses of the preschool Receptive-Expressive Language Scale(PRES)" 5 : 1-25, 2000

33 Kim YT, "Content and Reliability Analyses of the Sequenced Language Scale for Infants(SELSI)" 7 : 1-23, 2002

34 Watson LR, "Communicative gesture use in infants with and without autism : a retrospective home video study" 22 : 25-39, 2013

35 Freeman BJ, "Cognitive Processing of High-Functioning Autistic Children : Comparing The K-ABC and the WISC-R" 3 : 357-362, 1985

36 Luscombe D, "Capute and Accardo's Neuro-developmental Disabilities in Infancy and Childhood" 29 : 13-14, 2008

37 Lovaas OI, "Behavioral treatment and normal educational and intellectual functioning in young autistic children" 55 : 3-9, 1987

38 Bayler N, "Bayley scales of infant development" Psychol Co 1993

39 Cox A, "Autism spectrum disorders at 20 and 42 months of age : stability of clinical and ADIR diagnosis" 40 : 719-732, 1999

40 Chawarska K, "Autism spectrum disorder in the second year : stability and change in syndrome expression" 48 : 128-138, 2007

41 Baranek GT, "Autism during infancy : a retrospective video analysis of sensory-motor and social behaviors at 9-12 months of age" 29 : 213-224, 1999

42 Volkmar FR, "Autism and pervasive developmental disorders" 45 : 135-170, 2004

43 Clifford S, "Assessing the early characteristics of autistic disorder using video analysis" 37 : 301-313, 2007

44 Virues-Ortega J, "Applied behavior analytic intervention for autism in early childhood: meta-analysis, meta-regression and dose-response meta-analysis of multiple outcomes" 30 : 387-399, 2010

45 Srour M, "Analysis of clinical features predicting etiologic yield in the assessment of global developmental delay" 118 : 139-145, 2006

46 Kjelgaard MM, "An Investigation of Language Impairment in Autism : Implications for Genetic Subgroups" 16 : 287-308, 2001

47 Volkmar FR, "Age of recognition of pervasive developmental disorder" 142 : 1450-1452, 1985

48 Abrahams BS, "Advances in autism genetics:on the threshold of a new neurobiology" 9 : 341-355, 2008

49 Risch N, "A genomic screen of autism : evidence for a multilocus etiology" 65 : 493-507, 1999

50 설경인, "A Comparison of Receptive-Expressive Language Profiles between Toddlers with Autism Spectrum Disorder and Developmental Language Delay" 연세대학교의과대학 55 (55): 1721-1728, 2014