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초등학생 아동을 대상으로 K-ARS를 이용한 ADHD 관련 증상의 잠재계층 탐색

ADHD Latent Class and Its Relations to Comorbid Problems in A Korean Community Sample

오경자|이수진
한국임상심리학회 (Korean Clinical Psychology Association)|2011.08|Korean Journal of Clinical Psychology|제30권 제3호|pp. 703-721|DOI 10.15842/kjcp.2011.30.3.005

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참고문헌

키워드

ADHD잠재계층 분석과잉행동-충동성 증상K-ARSlatent class analysishyperactive-impulsive symptom
주제분류심리과학

초록

본 연구에서는 K-ARS(Korean ADHD Rating Scale)를 이용하여 ADHD 관련 증상에 대한 잠재계층 분석(LCA: Latent Class Analysis)을 통해 사회문화적으로 다른 우리나라에서도 서구의 기존 연구와 유사한 ADHD 잠재계층이 추출되는지를 확인해 보고자 하였다. 특히, ADHD 잠재계층으로서 과잉행동-충동성 우세형 집단에 대한 서로 불일치되는 연구 결과의 원인을 찾아보기 위해 연령에 따라 아동 집단을 구별한 후 잠재계층 분석을 실시하여 연령과 과잉행동-충동성 우세형 유형과의 연관성을 살펴보고자 하였다. K-ARS의 18문항에 대하여 1732명(남아 904명, 여아 828명)의 초등학생 아동을 연령에 따라 저연령군(6-7세) 집단, 중간 연령군(8-10세) 집단, 그리고 고연령군(11-12세) 집단으로 구분한 후 잠재계층 분석을 실시하였다. 잠재계층 분석 결과, 저연령군 집단에서는 5개의 잠재계층이 가장 적절한 잠재계층으로 추출되었으며, 이들은 2개의 복합형(증상의 정도에 따라 심각한 수준과 경미한 수준으로 구분됨) 집단과 1개의 부주의 우세형 집단, 1개의 문제없는 집단, 그리고 1개의 과잉행동-충동성 우세형 집단으로 구분할 수 있었다. 중간 연령군 집단 및 고연령군 집단에서는 6개의 잠재계층이 가장 적절한 잠재계층으로 추출되었으며, 이들은 3개의 복합형(심각한 수준, 중간 수준, 경미한 수준으로 구분됨) 집단과 2개의 부주의 우세형(심각한 수준과 경미한 수준으로 구분됨) 집단, 그리고 1개의 문제없는 집단으로 구분할 수 있었다. 그러나, 저연령군 집단에서 관찰되었던 과잉행동-충동성 우세형 집단은 중간 연령군과 고연령군 집단에서는 관찰되지 않았다. 또한, 서구 선행 연구에서 보고된 말이 많은 충동적(talkative-impulsive) 집단은 본 연구에서는 단독 잠재계층으로 나타나지 않았다. 이를 토대로 ADHD 잠재계층에 대한 기존 연구와의 유사점과 차이점, 그리고 시사점에 대해 논의하였으며, ADHD 정의 및 진단과 관련하여 ADHD 아동 연구를 위한 적절한 후속 연구 내용과 방법에 대해 제안하였다.

Abstract

The aim of this study is to explore the latent classes of ADHD in order to determine if the latent class structure of the ADHD subtypes found in western countries can be replicated in a sample of culturally different Korean children sample. Previous studies have shown inconsistency regarding hyperactive-impulsive subtypes: some studies have reported that there were no hyperactive-impulsive subtypes and others stated that there were indeed hyperactive-impulsive subtypes. Therefore, the present study sought the reasons for these discrepancies of the ADHD latent subgroups by classifying three different age groups using low, middle, and high age thresholds. The Korean version of the ADHD Rating Scale (K-ARS) was completed by 1732 mothers of children between the ages of 6 to 12 (904 boys and 828 girls) and who were attending elementary schools in the greater Seoul metropolitan area. Latent class analysis was applied to the 18 items of the K-ARS. LCA revealed a five-cluster ADHD model as the best fit with the non-symptomatic class and 4 ADHD classes for the children who were 6 to 7 years of age. The 4 ADHD classes can be grouped into three subtypes: 2 combined classes (Severe Combined or Mild Combined), 1 inattentive class, and 1 hyperactive-impulsive class. LCA also revealed the six-cluster ADHD models as the best fit with a non-symptomatic class and the 5 the ADHD classes as the best fit for children 8 to 10 and 11 to 12 years of age, respectively. The 5 ADHD classes can be grouped in two subtypes: 3 combined classes (Severe Combined, Moderate Combined or Mild Combined) and 2 inattentive classes (Severe Inattentive or Mild Inattentive) without a hyperactive-impulsive class. That is, the low age group was of the predominant hyperactive-impulsive class, but the middle and high age groups were not of the hyperactive-impulsive predominant class. In addition, no talkative-impulsive class emerged as a separate class in the present study, either. We also discuss the similarities and differences and their implications between the previous study and present study regarding the ADHD latent classes and comorbid problems.

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