TREATMENT OF ECHOLALIA IN CHILDREN WITH AUTISM

자폐아동의 반향어 치료

The purpose of this study was to investigate the possibility of providing familiar tasks as a treatment option to decrease echolalia. Two comparisons were made：One was to compare ‘conversation condition’ and ‘task performance condition.’ and the other was to compare ‘task performance alone condition’ and ‘task performance along with contingency of reinforcement condition.’ Two echolalic children aged 12 and 13 years participated in the experiment and A-B-A-B-BC-B-BC design was used, in which A was conversation only, B was task performance, and C was task performance along with contingency of reinforcement. In the A condition, the therapist asked easy and short questions to the child；in the B condition the child was given familiar tasks with short instruction, and in BC condition, each child was reinforced for his performance on given tasks, in which immediate echolalia was controlled through his hands being held down for 5 seconds. Delayed echolalia was recorded without any intervention being given. Each child was put into each of the 7 treatment conditions. With a 15 minutes session, each child went through 5 to 6 sessions per day for 2 weeks. The mean echolalia(immediate) rates across the 7 treatment conditions were：For child 1, A(99%)-B(65%)-A(95%)-B(10%)-BC(7%)-B(6%)- BC(7%) and for child 2, A(67%)-B(62%)-A(63%)-B(35%)-BC(8%)-B(4%)-BC(0%). As to the generalization of the treatment effect of immediate echolalia to the untreated delayed echolalia, there was shown a drastic reduction of delayed echolalia in child 2：A(35%)-B(57%)-A(56%)-B(40%)-BC(8%)-B(5%)-BC(9%). Child l’s delayed echolalia was negligible(mean=3%) pre-and post treatments. In conclusion, the results of this study clearly show that providing a task performance setting with familiar tasks can certainly be helpful for minimizing echolalic response, and along with the use of the contingency of reinforcement technique it can further not only correct echolalic behavior to a negligible degree but also help the echolalic child generalize its treatment effect to the child’ overall language improvement.

이 연구에서는 세 가지 치료조건을 조성하여 각 치료조건간의 반향어 발생률과 치료효과를 비교하였다. 치료조건1(A)은 치료사가 아동에게 쉽고 짧은 질문을 하는 ‘대화조건’ 이고, 치료조건2(B)는 아동이 치료사가 하라는 지시에 따라 쉬운 과제를 수행하는 ‘과제수행조건’ 이고, 치료조건3(C)은 보상과 통제를 사용하는 ‘강화의 조건’ 이다. 연구설계는 A-B-A-B-BC-B-BC를 사용하였다. 이 연구는 발달연령이 3~4세 수준인 2명의 남아(11세, 12세)에게 실시되었는데, 반향어 치료는 1회기에 15분씩, 하루에 5~6회를 2주간 실시하였다. 반향어 치료를 위한 개입은 즉각 반향어에만 적용했고, 지연 반향어는 치료 개입없이 관찰만 하였다. 아동1의 즉각 반향어 치료결과(평균 비율)는 A(99%)-B(65%)-A(95%)-B(10%)-BC(7%)-B(6%)-BC(7%)로 나왔고, 아동2의 치료결과는 A(67%)-B(62%)-A(63%)-B(35%)-BC(8%)-B(4%)-BC(0%)로 나왔다. 아동1의 지연 반향어는 치료 개입 전후를 통해 3% 수준으로 큰 차이없이 낮은수준을 유지했고, 아동2의 지연 반향어는 강화의 조건 병행 전에는 $35{\sim}57%$ 수준이던 것이 강화의 조건 개입 후에는 $5{\sim}9%$ 수준으로 감소하였다. 이 연구의 결론은 대화상황에서 아동의 반향어를 교정하기보다는 아동에게 쉬운 과제를 수행하는 학습환경을 조성해주는 것이 반향어를 감소시키는데 도움이 되고, 과제수행 학습환경에서 과제수행 행동을 보상하고, 반향어 행동을 통제하는 방법을 사용하면, 반향어 감소는 물론 반향어 치료효과가 아동의 전반적인 언어발달에도 긍정적인 영향을 줄 수 있음을 말해주고 있다.