Korean Journal of Psychosomatic Medicine (정신신체의학)

Korean Psychosomatic Society (한국정신신체의학회)
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Differences of Obstetric Complications and Clinical Characteristics between Autism Spectrum Disorder and Intellectual Disability

자폐스펙트럼장애와 지적 장애의 산과적 합병증 및 임상적 특성의 차이

  • Lee, Seul Bee (Department of Psychiatry, National Health Insurance Service, Ilsan Hospital) ;
  • Kim, Ji Yong (Department of Rehabilitation Medicine, National Health Insurance Service, Ilsan Hospital) ;
  • Chung, Hee Jung (Division of Pediatric Neurology, National Health Insurance Service, Ilsan Hospital) ;
  • Kim, Seong Woo (Department of Rehabilitation Medicine, National Health Insurance Service, Ilsan Hospital) ;
  • Im, Woo Young (Department of Psychiatry, Konyang University College of Medicine) ;
  • Song, Jung-Eun (Department of Psychiatry, National Health Insurance Service, Ilsan Hospital)
  • 이슬비 (국민건강보험공단 일산병원 정신건강의학과) ;
  • 김지용 (국민건강보험공단 일산병원 재활의학과) ;
  • 정희정 (국민건강보험공단 일산병원 소아신경과) ;
  • 김성우 (국민건강보험공단 일산병원 재활의학과) ;
  • 임우영 (건양대학교병원 정신건강의학과) ;
  • 송정은 (국민건강보험공단 일산병원 정신건강의학과)
  • Received : 2016.08.30
  • Accepted : 2016.12.12
  • Published : 2016.12.31
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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.

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.

Keywords

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