ADHD 아동·청소년을 위한 치료 및 돌봄의 원칙과 절차에 대한 고찰
A Review of Principles and Procedures for Treatment and Care of the Child & Adolescent with Attention-Deficit/Hyperactivity Disorder
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본 연구의 목적은 주의력결핍 과잉행동장애(ADHD) 아동의 부모와 교사들이 치료와 돌봄의 원칙과 절차를 정확히 이해하고, 돌봄 팀으로서 자신의 역할과 책임을 구체적으로 확인함으로써 ADHD의 치료 및 중재, 돌봄의 효과성을 높이기 위함이다. 이를 위해 대한소아신경학회, 대한소아청소년정신의학회, 미국소아과학회, 미국발달·행동소아과학회에서 발표한 ADHD 임상실무지침과 관련 연구들을 중심으로 전형적 ADHD 및 복합 ADHD 아동·청소년의 치료 및 돌봄의 원칙과 절차를 고찰하였고, 그 결과 다음과 같이 제언한다. ADHD는 만성적 질환이며 많은 경우, 동반장애나 학습 문제, 정신건강 문제 등 복합적인 장애 요인을 가지기 때문에 특성에 따른 증상 감소와 기능 개선을 위해 심리사회적 처치와 약물치료를 포함한 포괄적 접근이 필요하다. 따라서 국내 의학계에서는 ADHD 치료와 돌봄의 원칙과 절차를 체계적으로 안내하는 임상실무지침을 개발해야 하며, 복합 ADHD 진료를 위한 임상교육을 제공해야 한다. 또한 가정과 의료기관, 학교는 지속적이고 효과적인 돌봄을 위한 협력체제를 구축해야 하며, 학교에서 심각한 기능손상을 가진 아동에게 심리사회적 중재를 직접 제공할 수 있도록 특수교육적 지원을 모색해야 한다. 마지막으로 ADHD 치료와 돌봄은 가정과 학교, 지역사회의 맥락에서 아동 스스로 문제를 해결할 수 있도록 지원하는 방향으로 접근해야 한다.
Abstract
The purpose of this study is to improve the effectiveness of treatment, intervention, and care by ensuring that parents and teachers of children with Attention Deficit Hyperactivity Disorder (ADHD) understand the principles and procedures of treatment and care and identify their roles and responsibilities. To this end, the principles and procedures of treatment and care for children and adolescents with typical or complex ADHD were reviewed, focusing on ADHD clinical practice guidelines such as the Korean Child Neurology Society, the Korean Academy of Child and Adolescent Psychiatry, the American Academy of Pediatrics and the American Academy of Developmental and Behavioral Pediatrics. According to the results, we suggest the following. First, ADHD is a chronic disease and, in many cases, has complex disability factors such as comorbid disabilities, learning problems, and mental health problems, so a comprehensive and systematic approach including psychosocial treatment and drug treatment for symptom reduction and function improvement is required. Thus, the domestic medical society should develop clinical practice guidelines that systematically guide the principles and procedures of ADHD treatment and care, and provide clinical education for complex ADHD care. In addition, families, medical institutions and schools should establish a cooperative system for continuous and effective care and seek special educational support so that schools can directly provide psychosocial intervention to children with severe functional impairment. Finally, ADHD treatment and care should be approached in a way that supports children to solve problems themselves in the context of homes, schools and communities.
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