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자폐스펙트럼장애(ASD) 아동의 공존증상과 도전행동의 구조적 관계 탐색

Exploring the Structural Relationship between Comorbidities and Challenging Behaviors in Children with Autism Spectrum Disorder

송재옥|전병운
한국정서행동장애학회 (The Korean Society of Emotional and Behavioral Disorders)|2022.09|정서·행동장애연구 (JOURNAL OF EMOTIONAL & BEHAVIORAL DISORDERS)|제38권 제3호|pp. 29-58|DOI 10.33770/JEBD.38.3.2

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공존증상자폐스펙트럼장애ASD도전행동Challenging BehaviorAutism Spectrum DisordersComorbidity

초록

본 연구의 목적은 자폐스펙트럼장애(ASD) 아동에게 나타나는 도전행동과 관련 변인 간의 구조적 관계를 탐색하여 도전행동의 예측 경로를 밝히는 것이다. 본 연구의 대상은 국내 특수학교와 초⋅중⋅고등학교 특수학급에 재학 중인 6∼18세의 ASD 아동 668명이며, 설문은 이들을 6개월 이상 지도한 담임교사가 답하였다. 정보 제공자인 담임교사는 ASD 아동의 인구통계학적 정보, 자폐증상심각도, 표현언어능력, 불안, 우울, 주의력결핍 과잉행동, 수면문제, 도전행동 등에 관련된 온라인 설문에 답하였다. 연구의 결과는 다음과 같다. 첫째, 자폐증상심각도와 수면문제는 ASD 아동의 모든 공존증상을 직접적으로 유의하게 예측하는 것으로 나타났다. 또한 자폐증상심각도가 수면문제를 매개로 하여 우울, 불안, 주의력결핍 과잉행동을 예측하는 경로도 모두 유의한 것으로 나타났다. 둘째, 표현언어능력은 ASD 아동의 도전행동을 부적(-)으로 예측하였으며, 불안, 우울, 주의력결핍 과잉행동은 ASD 아동의 도전행동을 정적(+)으로 예측하였다. 셋째, 자폐증상심각도는 도전행동을 직접적으로 예측하지는 않았으나 수면문제, 불안, 주의력결핍 과잉행동 등의 공존증상을 매개로 하여 도전행동을 예측하였다. 또한 수면문제도 직접적으로 도전행동을 예측하지는 않았으나 불안과 주의력결핍 과잉행동을 매개로 하여 도전행동을 예측하였다. 모든 특정간접효과 경로에서 우울이 포함된 경로는 유의하지 않았다. 이와 같은 결과를 바탕으로 논의와 제언을 하였다.

Abstract

The purpose of this study is to identify the risk factors that predict comorbidities and challenging behaviors. The subjects of the present study were 668 6-18-year-old ASD children enrolled in special schools and special classes in elementary, middle, and high schools nationwide, and the information provider for them was the homeroom teacher who had known them for at least six months. Teachers of children with ASD were asked to complete the following online survey about the children with ASD, such as their demographic information, autism symptom severity, expressive language skills, anxiety, depression, attention deficit hyperactivity, sleep problems, and challenging behaviors. A structural equation model analysis was used to identify the predictors of comorbidities and challenging behaviors of children with ASD and to assess significant pathways for predicting challenging behaviors. The research findings are as follows. First, autism symptom severity and sleep problems significantly predicted all comorbidities in children with ASD. Sleep problems mediated the relationship between autism symptom severity and each comorbidity. Seconds, expressive language ability negatively predicted challenging behaviors in children with ASD, while anxiety, depression, and attention deficit/hyperactivity positively predicted challenging behaviors of children with ASD. Thirds, autism symptom severity did not directly predict challenging behavior, but it did predict challenging behavior by mediating comorbidities, such as sleep problems, anxiety, and attention deficit/hyperactivity. Further, sleep problems did not predict challenging behavior directly, but they did predict challenging behavior by mediating anxiety and attention deficit/hyperactivity. None of the specific indirect effects, including depression, were significant.

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