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DSM-5의 자폐스펙트럼장애에 관한 10문 10답

Ten Questions and Answers about Autism Spectrum Disorder in the DSM-5

이승희
한국정서행동장애학회 (The Korean Society of Emotional and Behavioral Disorders)|2014.09|정서·행동장애연구 (JOURNAL OF EMOTIONAL & BEHAVIORAL DISORDERS)|제30권 제3호|pp. 1-33

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키워드

DSM-5자폐스펙트럼장애ASDAutism Spectrum Disorder

초록

2013년 DSM-5가 발행되어 2000년에 발행된 DSM-Ⅳ-TR을 대치하였다. DSM-5에 나타난 가장 두드러진 변화 중 하나는 전반적 발달장애(PDDs)의 하위유형들을 단일범주인 자폐스펙트럼장애(ASD)로 통합한 것이다. 그러나 이 변화는 DSM-5의 공식적인 출간 전후로 논쟁의 중심에 서게 되면서 연구자, 임상가, ASD를 가진 아동의 부모와 교사들에게 큰 관심사로 부각되고 있다. 따라서 본 연구는 이러한 논쟁과 관련된 10개의 연구문제를 설정하여 체계적으로 살펴봄으로써 DSM-5 ASD를 둘러싼 논쟁에 대한 정보를 제공하고자 하였다: 첫째, DSM-5에서 PDDs라는 용어 대신 ASD를 사용한 이유는 무엇인가? 둘째, DSM-5 ASD에는 DSM-Ⅳ-TR PDDs의 어떤 하위유형이 포함되는가? 셋째, DSM-5 ASD에서 스펙트럼은 연속체와 어떤 차이가 있는가? 넷째, DSM-5 ASD에 대한 차원적 접근이란 어떤 의미인가? 다섯째, DSM-5 ASD의 주요특징은 무엇인가? 여섯째, DSM-5 ASD의 중증도 단계는 적절한가? 일곱째, DSM-5 ASD 진단준거와 DSM-Ⅳ-TR 자폐장애 진단준거의 관계는 어떠한가? 여덟째, DSM-5 ASD 진단준거에 의한 출현율은 어떠한가? 아홉째, DSM-5 ASD 진단준거의 민감도와 명확도는 어떠한가? 열째, DSM-5 ASD의 최종진단준거는 초안진단준거와 어떤 차이가 있는가? 10개의 연구문제별로 DSM-5(2013)와 관련문헌들을 고찰한 후 결론을 제시하였다. 마지막으로 이러한 고찰과 결론을 근거로 향후 DSM-5 ASD와 관련된 연구 및 임상에 대한 몇 가지 시사점을 제언으로 제시하였다.

Abstract

DSM-5 was published in 2013, superseding DSM-Ⅳ-TR which was published in 2000. One of notable changes in DSM-5 is to merge the subtypes of pervasive developmental disorders(PDDs) into a single category of autism spectrum disorder(ASD). However, this change was in the center of dispute before and after DSM-5 was formally published and then has received considerable attention from researchers, clinicians, and parents and teachers of children with ASD. Therefore, this study aimed to provide information on the dispute around DSM-5 ASD by formulating 10 research questions related to the dispute and examining them systematically. The 10 research questions were as follows: (a) What is the reason that the term PDDs was replaced with ASD in the DSM-5? (b) What subtypes of DSM-Ⅳ-TR PDDs are included in DSM-5 ASD? (c) What is the difference between spectrum in DSM-5 ASD and continuum? (d) What does a dimensional approach to DSM-5 ASD mean? (e) What are the essential features of DSM-5 ASD? (f) Are the severity levels for DSM-5 ASD appropriate? (g) What is the relationship between ASD diagnostic criteria in the DSM-5 and autistic disorder diagnostic criteria in the DSM-Ⅳ-TR? (h) What is the prevalence based on DSM-5 ASD diagnostic criteria? (i) What is the sensitivity and specificity of DSM-5 ASD diagnostic criteria? (j) What is the difference between final diagnostic criteria and draft diagnostic criteria of DSM-5 ASD? After reviewing DSM-5(2013) and related literature according to the 10 questions, 10 answers were provided as conclusions. Finally, based on the review and conclusions, several suggestions were presented for future research and clinic related to DSM-5 ASD.

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