DSM-5 ASD 진단준거의 B4(비정상적 감각반응)에 대한 쟁점과 과제
Issues and Tasks for the B4(Abnormal Sensory Response) of ASD Diagnostic Criteria in the DSM-5
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미국정신의학회가 2013년 발간한 DSM-5에는 많은 변화가 있었는데, 가장 큰 변화 중 하나는 전반적 발달장애(PDDs)의 5개 하위유형이 단일범주인 자폐스펙트럼장애(ASD)로 통합되었다는 것이다. 그리고 ASD의 진단준거에 DSM-Ⅳ-TR까지 자폐장애의 부수적인 관련특징으로 기술되었던 비정상적 감각반응이 진단준거 항목(B4)으로 새로 포함되는 변화도 있었다. 그러나 새로 ASD 진단준거에 포함된 B4(비정상적 감각반응)에 문제점이 나타나고 있다. 따라서 본 연구에서는 이러한 문제점을 다섯 가지 쟁점(B4와 ASD진단의 관계, B4와 과잉선택성의 관계, B4와 상동행동의 관계, B4와 감각통합이론의 관계, B4와 뇌체계이론의 관계)으로 설정하고 각 쟁점별로 구체적으로 살펴본 후 다음과 같은 향후 과제를 제시하였다. 첫째, DSM-5 ASD B4의 내용이 여러 측면(예: 심각도 단계, 비정상적 감각반응의 패턴, 비정상적 감각반응이 나타나는 감각체계)에서 양적으로 그리고 질적으로 보완되어야 한다. 둘째, 과잉선택성이 ASD의 비정상적 감각반응 및 다른 주요증상과 어떤 관계에 있는지에 대한 탐색이 필요하다. 셋째, 상동행동과 자해행동 그리고 첨족보행을 비정상적 감각반응의 일환으로 볼 수 있는지에 대한 연구가 필요하다. 넷째, 작업치료사에 의해 감각통합장애(또는 감각처리장애) 진단을 받은 ASD아동들의 감각처리패턴에 대한 체계적인 연구가 필요하다. 다섯째, 신경학적 역치 및 각성과 관련된 B4에 대한 이해를 높이기 위해 행동억제체계(BIS)와 행동활성체계(BAS)의 활동도에 대한 연구도 필요하다.
Abstract
There was a lot of changes in the DSM-5 published by the APA in 2013. One of the big changes in the DSM-5 was to integrate five subtypes of pervasive developmental disorders(PDDs) into a single category of autism spectrum disorder(ASD). There was also a change of including abnormal sensory response(B4) in diagnostic criteria, which was described as a associated feature of autistic disorder in the DSM-Ⅳ-TR. However, there have appeared some problems on the B4(abnormal sensory response) that was newly included in the ASD diagnostic criteria. Therefore, this study aimed to classify the problems into five issues(relationships of B4 to ASD diagnosis, overselectivity, stereotypic behavior, sensory integration theory, theory of brain systems) and examine each issue specifically, and then propose future tasks. Proposed future tasks were as follows: (a) The contents of B4 in the DSM-5 ASD should be complemented both quantitatively and qualitatively in several aspects(e.g., severity level, patterns of abnormal sensory response, sensory systems in which abnormal sensory response appears). (b) There is a need for investigation on the relationships of overselectivity to abnormal sensory response and other core features of ASD. (c) It is needed to examine whether stereotypic behavior, self-injurious behavior, and walking on tiptoes can be considered a part of abnormal sensory response. (d) There is a need for systematic research on sensory processing patterns of children with ASD, who are also diagnosed with sensory processing disorder by a occupational therapist. (e) It is also needed to investigate the activity of behavioral inhibition system(BIS) and (behavioral activation system(BAS) in order to better understand B4 in relation with neurological thresholds and arousal.
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