주의력결핍 과잉행동장애의 진단 및 치료 평가에서 평가척도 및 연속수행검사의 관련성 및 유용성
The Efficacy of ADHD Rating Scale and Continuous Performance Tests in Diagnosis and Treatment of Attention Deficit Hyperactivity Disorder
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목 적 : 주의력결핍 과잉행동장애(attention deficit hyperactivity disorder: ADHD)는 소아기에 발생하는 부주의, 충동성, 과잉행동을 주요 증상으로 하는 신경발달장애 질환이다. 부모, 교사 등 관찰자와의 면담을 통한 병력청취와 세심한 환자 관찰에 의하여 DSM-IV 기준에 의해서 진단된다. 이 질환을 검사하여 진단을 내릴 수 있는 특수한 검사 도구는 존재하지 않지만 진단에 도움을 주는 검사로 ADHD 평가척도와 연속수행검사가 있다. 이에 저자들은 ADHD의 진단 및 치료 효과의 평가에 있어 검사 도구들의 유용성에 대하여 알아보고자 하였다. 방 법 : 한림대학교 강남성심병원과 강동성심병원 소아청소년과에 2007년 1월부터 2008년 6월까지 ADHD의 진단을 위해서 내원한 환자 중 DSM-IV 진단 기준에 합당한 41명을 대상으로 하였다. 대상 환자들에서 병력 청취, 이학적 검사, ADHD 평가척도로 ACRS, K-ARS를 실시하였고, 연속수행검사 중 컴퓨터를 이용해 전산화된 검사로 ADS를 시행하였으며 중추신경자극제 치료 후에 동일한 검사를 시행하여 그 결과를 비교 분석하였다. 결 과 : 대상 환자의 남녀 비는 4.13:1(33:8)이었고 평균나이는 8.44±2.49세였으며 임상양상에 따른 아형으로 나누었을 때 주의력 부족이 주된 증상인 경우 17명(41.5%), 행동 과다가 주된 증상인 경우 3명(7.3%), 혼합형인 경우가 21명(51.3%)이었다. DSM- IV 진단 기준에 의해 ADHD로 진단되었던 소아 및 청소년에서 ADS 검사는 38명(92.68%), K-ARS는 26명(74.29%), ACRS는 13명(59.09%)으로 ADS가 가장 높은 일치율을 보였다. 중추신경자극제로 치료 후 효과를 판정할 때 ADS에서 각 항목의 총합이 치료 전 513.67±135.81, 치료 후 440.80±111.90로 유의하게 감소하였다(P<0.05). 결 론 : ADHD 소아청소년들에서 ADS가 다른 검사들에 비교하여 DSM-IV 진단기준과 진단의 일치율이 높았고, 중추신경자극제 치료 후에 치료 효과를 판정할 때도 다른 검사들에 비하여 더 예민하다는 것을 알 수 있어 향후 ADHD 진단과 치료 평가에 평가척도와 더불어 ADS를 함께 실시하는 것이 도움이 될 것으로 사료된다.
Abstract
Purpose : Attention deficit hyperactivity disorder(ADHD) is a neurodevelopmental disorder characterized by symptoms of inattention, impulsivity and/or hyperactivity with an onset during childhood. There are no specific diagnostic and evaluated tools. The aim of this study was to determine clinical availability of adjunctive tests for diagnosis and measure of the efficacy of treatment in ADHD patients. Methods : The study group consisted of 41 patients under 15 years of age who visited Kangnam Sacred Heart Hospital and Kangdong Sacred Heart Hospital between January 2007 and June 2008 for evaluation of ADHD. Diagnosis was made according to the diagnostic and statistical manual for mental disorder-IV(DSM-IV) with history, physical examination, ADHD rating scale, and attention deficit hyperactivity disorder diagnostic system(ADS). After psychostimulant treatment, patients were reevaluated by previous diagnostic tools and their results were analysed by SPSS version 16.0. Results : The mean age was 8.44±2.49 years old, male to female ratio 4.13:1(33:8). Forty one ADHD patients were subdivided into predominantly inattentive type 17(41.5%), predominantly hyperactive-impulsive type 3(7.3%) and combined type 21(51.2%). In patients, concordance rates of adjunctive tests with DSM-IV diagnostic criteria were 74.29% in Korean ADHD Rating scale(K-ARS), 59.09% in abbreviated Conners' rating scale(ACRS) and 92.68 % in ADS with DSM-IV diagnostic criteria. There were significant differences in the ADS results between before and after psychostimulant treatment. Conclusion : Because the concordance rates and efficacy of ADS were higher than K- ARS and ACRS in ADHD patients, it suggests that ADS is a useful method to ADHD diagnosis and treatment.
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