자폐스펙트럼장애 아동의 화용론적 중재에 관한 사례연구
A Case Study on Intervention for Socio-Pragmatic Language Skills of Children with Autism Spectrum Disorder
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초록
본 연구는 자폐스펙트럼장애를 가진 초등학교 남학생 2명을 대상으로 사회이야기와 다량연습을 활용한 다요인 행동중재가 대화에서의 질문하기와 반응하기 행동에 미치는 영향을 살펴본 사례연구이다. 대상아동 2명은 일상적인 의사소통에는 문제가 없으나 또래들과의 대화가 이루어지지 않아 교우관계에 어려움을 겪는 아동들로 대화에서 질문하기나 반응하기를 전혀 혹은 거의 나타내 보이지 않는 아동들이었다. 중재로는 이러한 기술이 왜 중요하며 구체적으로 어떻게 실행하는가를 알려주는 사회이야기와 이러한 행동을 다량으로 연습하고 연습과정에서 피드백과 교사의 모델링이 포함되는 다요인 행동중재 방법이 활용되었다. 중재는 개별적으로 실시되었고, 실험설계는 행동간 중다기초선 설계로 두 아동에 대해 반복 측정하였다. 자료수집은 자폐스펙트럼장애아와 비슷한 연령의 일반아와의 약간 구조화된 4분간의 대화를 관찰함으로써 이루어졌으며 분석은 대화 도중 아동이 말한 전체 차례 중에서 두 행동이 발생한 차례의 퍼센티지를 산출하여 살펴보았고, 질적으로 행동 양상의 변화를 살펴보았다. 일반화와 효과의 유지를 관찰과 교사면담을 통하여 살펴보았다. 중재 결과 자폐스펙트럼장애 아동의 질문하기와 반응하기는 양적인 측면에서는 개선이 이루어졌으나, 인지 기능의 특성에 따라 그 유형과 내용에서는 질적인 차이가 있었다. 또한 일반화와 유지효과가 있는 것으로 나타난 관찰결과와는 달리 교사와의 면담을 통한 검증에서는 한 아동에게서만 효과가 있는 것으로 나타났다. 연구결과에 근거한 논의와 후속연구에 대한 제안이 이루어졌다.
Abstract
Children with autism spectrum disorder struggle to maintain conversations. Learning appropriate conversational skills can be an important step in creating friendships. The purpose of this study was to examine the effects of a multicomponent intervention including social story and multiple exemplar training on how to ask questions and respond to a speaker during conversation in children with autism spectrum disorder. Two male elementary school students with autism spectrum disorder participated in this study. The procedure for training conversational question and responding consisted of two parts: reading social story aloud and oral response to comprehension questions and practicing multiple examples with feedback and modeling. Training sessions were held 2∼3 times a week and each training session lasted 30∼40 minutes. The two target skills were measured during 4-minute low structured conversations with peers within the same age group. A multiple-baseline design across behaviors and replicated across participants revealed that both participants increased in the rate of both of questioning and responding. However qualitative analysis showed differences between the two children according to their intellectual functioning in asking questions and responding. A child with higher intellectual functioning corresponded with a wide range of questions and responding while a child with a lower intellectual functioning resulted in a much more restricted range of questioning and responding. In generalization, they showed different results while the former fully generalized the skills to natural conversational interactions with a typical peer, the latter showed limited generalization to those interactions.
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