주의력결핍 과잉행동장애의 의료적 진단에 대한 고찰
A Review on the Medical Diagnosis of Attention Deficit Hyperactivity Disorder
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본 연구에서 주의력결핍 과잉행동장애의 의료적 진단에 대해 고찰한 결과, 진단 체계인 WHO의 ICD-10(HKD)와 APA의 DSM-IV(ADHD)에서는 공통적으로 연령과 발달에 맞지 않는 행동적 증상의 지속적 발현과 2개 이상 환경에서의 기능적 손상, 아동기 발병 등을 제시하고 있으며, HKD는 심한 형태의 ADHD 아형 또는 복합형에 해당한다고 볼 수 있다. 최근의 ICD-11와 DSM-5에서는 매우 유사한 ADHD 진단 체계와 기준을 제시하고 있다. 진단 지침에서는 ADHD 선별을 보편적 정신건강 평가에 포함시키고, DSM의 진단 준거 및 부모와 교사로부터 수집한 직접적 정보, 공존장애 평가 등에 근거한 의사의 임상적 판단을 요구하고 있다. 국내 ADHD 진단 실태를 살펴보면 2017년 HKD 유병률은 0.11%이며 총 요양급여비용은 약 282억, 1인당 평균 477,093원이었다. HKD 중 활동성 및 주의력장애(F90.0)의 전체 유병률은 0.10%, 20세 미만은 0.52%(남성 0.83%, 여성 0.19%)였고 서울과 광역시에 편중되어 있다. 진료는 주로 의원급에서 이루어지고 있으며 의과의 평균 내원 일수는 8.8일, 급여비용은 472,230원으로 나타났다. 앞으로 의료적 진단의 타당성을 높이기 위해서는 임상의와 부모, 교사가 함께 참여하는 ‘medical home’과 같은 팀 접근이 이루어져야 하며 최근의 ADHD 진단 기준 및 의료보험 체계, 사회적 인식 등의 변화에 따른 추적 연구가 필요하다.
Abstract
In this study, medical diagnostic criteria, diagnosis guidelines and diagnosis status of attention deficit hyperactivity disorder were discussed. The results are as follows. ICD-10(HDK) and DSM-IV(ADHD), which are diagnostic systems for attention deficit hyperactivity disorder, have commonality and differential characteristics and ICD is more strict. Recently ICD-11 and DSM-5 have provided very similar diagnostic systems and standards. Diagnostic guidelines require that ADHD screening be included as part of a universal mental health assessment, based on DSM diagnostic criteria, direct information from parents and teachers, and evaluation of coexistence disorders. ICD-10(HKD) and DSM-IV(ADHD), which are diagnostic systems for attention deficit hyperactivity disorder, have commonality and heterogeneity, and although HKD has been recognized as a more serious disorder. Recently ICD-11 and DSM-5 offer very similar diagnostic systems and criteria. Diagnostic guidelines require that ADHD screening be included as part of a universal mental health assessment, based on DSM diagnostic criteria, direct information from parents and teachers, and evaluation of coexistence disorders. In 2017, the prevalence of HKD was 0.11%, and the medical care benefit was about 28.2 billion won, an average of 477,093 won. It is necessary to continuously monitor the impact of recent changes in diagnostic criteria and health insurance system. The prevalence of F90.0(Disturbance of activity and attention) was 0.10% and 0.52% (0.83% for male and 0.19% for female) under the age of 20, and it was concentrated in Seoul and metropolitan cities. Patients are mainly treated at the primary care facility, including Korean medicine clinics. The average number of days of medical visit was 8.8 days, and the cost of medical treatment was 472,230 won.
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