주의력결핍 과잉행동장애 아동의 주의집중력의 특성 : 시각 및 청각 TOVA와 지능검사 결과를 중심으로

최보문,이방락 大韓神經精神醫學會 2000 신경정신의학 Vol.39 No.5

연구목적: 주의집중력의 장애를 주 호소로 내원한 임상 아동들 중에서 주의력 결핍 과잉행동 장애로 진단된 아동과 기타 임상집단 아동의 주의력이 지능지수와 시각및 청가 TOVA에서 어떻게 나타나는지 알아보고자 본 연구를 시도하였다. 방법: 주의집중력의 장애를 주 호소로 내원한 47명의 환아중, 주의력결핍 과잉행동 장애로 진단된 24명의 아동과 그 외의 질환으로 진단된 23명의 아동을 대상으로 하였다. 두 대상 집단의 지능검사를 변인으로 하여 시각및 청각 TOVA의 결과를 비교하였다. 결과: ADHD 집단의 아동은 non-ADHD 아동과 비교하여 볼 때 전체 지능지수, 언어성 및 동작성 지능에서 모두 낮았으며, 공통성과 어휘를 제외한 전 소항목에서 특히 의의있게 낮은 것으로 나타났다. 진단 상태에 따른 TOVA결과에서, ADHA 아동의 79.1%가 시각 TOVA에 의하여, 100%가 청각 TOVA에 의하여 장애가 있다고 해석되었다. 시각 및 청각 TOVA가 ADHD와 non-ADHD를 정확하게 진단해낸 비율은 시각-TOVA의 경우 67.8%, 청각-TOVA의 경우 60.8%이었다. 시각 TOVA 중 오경보 오류 변인에서 ADHD 아동이 총 시간당 의의있게 수행이 저하되어 있었으며 특히 전반 1/2 에서 더 수행이 떨어지는 것으로 나타났다. 청각 TOVA에서는 ADHD아동의 누락오류 변인의 후반 1/2 및 총 시간당 수행에서 모두 수행이 떨어지는 것으로 나타났다. 결론: 주의집중력의 장애를 호소하는 임상 아동 중에서 주의력 결핍 과잉행동장애로 진단된 아동은 다른 임상진단 아동에 비하여, 지능검사상 기호쓰기, 숫자, 이해의 소항목에서 의의있게 수행이 저하되어 있었고, TOVA에서는 시각TOVA의 오경보 오류 변인의 전반 1/2 및 총시간에서, 청각 TOVA의 경우 누락 오류변인의 후반 1/2 및 총시간에서 수행이 저하되어 있었다. 지능검사 결과상의 세가지 항목과 시각 및 청각 TOVA의 누락오류변인이 충동조절 능력을 반영한다고 할 때, ADHD 아동은 임상집단 아동에 비하여 충동조절의 장애가 뚜렷한 것임을 시사하고 있다. 중심단어:주의집중력·TOVA-청각·충동통제. Objectives: The purpose of the study was to evaluate how the visual and auditory TOVA along with the IQ scores can differentiate the attentional deficit, both in children with ADHD only and in children with clinical diagnoses other than ADHD. Method: Forty seven children were divided into two groups, who were diagnosed as ADHD only and non-ADHD. One child & adolescent psychiatrist and one clinical psy-chologist were involved in the diagnostic process. Psychological tests battery including TOVA-visual and auditory was applied to all children. The raw data from the results was analyzed statisically by ANCOVA. Results: ADHD children were significantly scored lower in total IQ scores, as well as in all the subscores of IQ tests except similarities and vocabulary, though all of the children were classified within normal limit in terms of total IQ scores. Among the subscores of the IQ tests, the scores of arithmatic, digit span and coding were more significantly lower in ADHD children were significantly more impaired in performance in the variables of commission for the first half & total with visual TOVA, in the variables of commission for the second half & total with auditory TOVA. Conclusion: The ADHD children could be differentiated by the variables of both com-mission and variability of auditory TOVA. Assuming that the subscores of arithmatic, digit span and coding in the IQ test, as well as the variables of commission and variability of auditory TOVA reflect the ability of impulse control, the results suggest that the ADHD children would be more impaired in impulse-control than the children diagnosed other than ADHD. KEY WORDS: ADHD·TOVA-auditory·Impulse-control.

가정보육시설과 기관보육시설의 질적 특성과 영아의 사회·정서 발달

최보가,문영경 대한가정학회 2004 Human Ecology Research(HER) Vol.42 No.1

The purposes of this study were to investigate the quality (structure and process) of home-based day care and center-based day care, and to examine socioemotional development among infants who were in both types of day care. The subjects of this study were 101 infants who were in home-based day care and 181 infants who were in center-based day care. The measurements were socio-emotional development scale and assessment scales for day care programs. Results indicated that, first, home-based day care did not significantly differ from center-based day care in terms of structure. Second, home-based day care were, to some degree, significantly different from center-based day care in the process: home-based day care had better play environment and play activities than did center-based day care. Lastly, there were significant differences in socio-emotional development among infants according to the type of day care: infants in home-based day care were more independent to their teacher and felt more secure in child care homes than was true for the infants in center-based day care.

Methylphenidate 투약에 따른 주의력결핍 과잉운동장애 아동의 청각 사건관련전위의 변화

최보문,이성필,한상익,성양숙 大韓神經精神醫學會 1997 신경정신의학 Vol.36 No.2

Objects : Event related potential(ERP) has been recently applied to examine the neurophysiological disturbance in attention deficit hyperactivity disorder(ADHD), particularly with regard to N100 &P300 which are known as one of ERP components closely linked with cognitive function. On the basis of these aspects, this study was designed to evaluate electrophysiologic cfaracteristics and its availability for diagnosis and treament of ADHD children by comparison of ERP between normal controls and ADHD children before and after metylphenidate(MPD) administration. Methods : We examined the topograhic auditory ERP and T. O. V. A. (Test of variables of attention), a standardized computerized visual continuous performance test following adminstration of stimulant drug, MPD 10㎎ in 13 ADHD children and compared these results with those of 11 normal controls. Results : The results were as follows : 1) Though the difference was not stastically significant(P=0.0548), N100 latencies seemed to be longer in ADHD children than in normal controls. N100 amplitudes also seemed to be larger in ADHD children than in normal controls(P=0.0629). 2) The P300 latencies significantly shortened after MPD administration when compared with those before MPD administration in ADHD group(P<0.01). 3) ADHD group performed significantly less well than normal controls in T.O.V.A.(P<0.05). And T.O.V.A. scores significantly improved after MPD administration in ADHD group(P<0.01). 4) The N100 & P300 latencies and the T.O.V.A. scores were significantly correlated before MPD administration in ADHD group(P<0.05). 5) The P300 latencies before MPD administration were significantly correlated with the amplitudes of changes of T.O.V.A. scores after MPD administration(P<0.05). Conclusion : It seemes that prolonged N100 latency of ADHD children can be regarded as a relatively enduring trait marker and that P300 latency may reflect attentional response ability along with therapeutic effect by stimulant.

地域綜合開發計劃의 背景과 實際 : 경산지역을 중심으로 A Case of Kyongsan Region

최외출,박노보,김문식,정하광,이정주 영남대학교 지역발전연구소 1995 새마을지역개발연구 Vol.17 No.-

The purpose of this study is to examine background and characteristics of integrated rural development policy facing localization ages and to find out the effective ways for integrated rural development planning responding local settlement development and local autonomy. For this study, the case of Kyongsan region development planning was adopted. Policy issues were summarized as follows : 1. Endeavours for self-reliant regional development should be region-wide. Especially, residents, local government, local council, and local group concerned should be integrated through mutual cooperation. 2. Policy processes, including policy agend setting, policy making, policy implementation, policy evalution, should be opened to the public and should be institutionalized with the arrangement of participation of residents and experts. 3. Institutional arrangement should be made to compensate for scarce resources for regional development.

地域綜合開發計劃의 樹立을 爲限 住民開發需要調査 分析 : 慶尙北道 永川郡事例를 中心으로 A case study of the Youngchen Gun , Kyngsang Buk Do

최외출,박노보,김문식,정하광,이정주 영남대학교 지역발전연구소 1995 새마을지역개발연구 Vol.17 No.-

The purpose of this study is to establish the integrated rural development plan based on the consciousness and development need of inhabitants in Youngchen Gun. Youngchen Gun is located near metropolitan Taegu city. It is a satellite town of Taegu. In the future it will become an industrial, educational center in a gardenlike environment. Youngchen Gun is an area having high level of the settlement consciousness in comparison with the other counties in Kyngsang Buk Do, but it has as ever the structural problem of rural. Obtained results of this study are as follows : 1. In a section of regional settlement consciousness, it is needed to establish the well organized settlement system. 2. In a section of zone of life, it is necessary to expand a marketing route for inhabitants. 3. In a section of agricultural industry, it is needed to expand the facilities for circulation, to improve an income crops and mechanize an agriculture. 4. In a section of residence, it is needed to expand the facilities of life benefit and enlarge housing lands. 5. In a section of transportation, it is needed to extend all sort of roads and traffic facilities. 6. In a section of education, it is necessary to elevate the qualities of education and modernize the education facilities. 7. In a section of medical service, it is needed to increase the medical specialist and expand medical facilities. 8. In a section of cultural service and welfare, it is necessary to establish and increase cultural and welfare facilities.

한국 신경정신의학의 연구경향에 대한 고찰

최보문,이성필,백인호 최신의학사 1985 最新醫學 Vol.28 No.3

"학교 붕괴"현상과 부등교자에 대한 정신의학적 고찰

최보문 대한신경정신의학회 2000 신경정신의학 Vol.39 No.6

연구목적: 이 종설은 현재 한국의 청소년에게 가장 심각한 갈등 요인으로 여겨지는 학교붕괴 현상을 이해하기 위한 것이다. 방 법: 그동한 '학교붕괴'에 관한 논의가 시린 책과 논문 및 보도된 메스컴으로부터 자료와, 이 현상과 연관되는 주제로서 부등교자에 대한 자료들을 정리하였다. 그리고 학교 제도와 한국의 부등교자에 대하여 발달학적, 정신의학적으로 고찰하였다. 결론 : '학교붕괴'의 현실에서 학교를 중퇴하는 청소년들이 특성이 과거와 변화하고 있음을 보고하였다. 타의에 의한 중퇴보다는 자발적 중퇴자가 더 증가하였고 이를 학교와 사회의 구조적 변화와 연관시켜 고찰하여 보았다. 급변하는 사회에서 적응양상이 변화하고 있는 청소년을 사회 속의 개인이라는 맥락에서 새로운 시각으로 보아야 한다는 점을 강조하였다. 아울러 학교를 거부하는 청소년에 관하여 그 개인적 요인에 대한 연구는 물론, 학교구조와 사회와의 상호의존적 관계에 대한 연구가 이루어져야 함을 지적하였다. Objectives : This review strives to look through the reality of school situation in Korea which give the most severe burden of conflict to adolescents nowadays, for the purpose of better understanding of them. Methods: Followings comprised of the summary of the materials from the published articles and books, and from mass media regarding 'school collapse' phenomenon in Korea, and also include materials regarding school non-attenders. And discussion was done with developmental and psychiatric perspectives on the phenomenon along with on school non-attenders. Conclusion : School non-attenders nowadays with the issue of 'school collapse' have different characteristics from the dropouts reported in many previous studies. Psychiatrists need to accommodate their previous view on adolescents as the way of adolescents' coping has rapidly changed. It is noted that there are few researches regarding school non-attenders, as well as regarding school factors associated with non-attending in Korea. This review was done to call for future studies focused on the interdependent relationship between school processes and the individual characteristics of non-attenders, so that enable us to capture the complexity of how adolescents make their decision of hanging-in or dropping-out of school.

주의력 결핍 과잉운동장애의 신경생물학적 측면

최보문,김종은 大韓神經精神醫學會 1990 신경정신의학 Vol.29 No.4

Since the reports on the effect of stimulants in controlling motor restlessness, inattention and distractibility, efforts have been made to elucidate the mechanism of action of the stimulants, and pathophysiology of the attention deficit hyperactivity disorder. This review has attempted to summarize biological findings on attention deficit hyperactivity disorder, from the fields of neuropharmacology and neuroanatomy. Most of the studies demonstrated that catecholamine function and its modulation are very probably involved at some level in the pathogenesis and treatment of this disorder. Reports on several neuroanatomical lesions also have implications for the catelcholamine hypothesis of the disorder. Further studies focusing on the response to stimulants and physiological studies using brain imaging technology will provide more comprehensive model of the pathophysiology of the attention deficit hyperactivity disorder.

천식아동의 행동장애와 임상요인과의 연관성

최보문 大韓神經精神醫學會 1996 신경정신의학 Vol.35 No.1

천식환아의 행동장애는 천식이라는 질병자체에 의한 생물학적 조건과 만성 질환을 앓는 데에 따라오는 이차적 환경조건이 그 발현에 영향을 미치고 있다. 그러므로 천식환아의 행동특성을 조사할 때에는 단순한 역학조사보다는 임상적 요인, 생물학적 조건 및 심리적, 환경적 조건등이 고려되어야 한다. 본 연구에서는 천식환아 28명을 대상으로 부모와 교사가 평가한 환아의 행동특성을 임사요인 및 이학적 검사소견관 비교 분석하여 보았다. 임상요인으로는 천식의 유병기간, 천식의 심각도 및 알레르기의 가족력이, 이학적 검사소견으로는 혈중 호산구수, 혈청 면역글로블린 E 및 메타콜린 부하검사가 포함되었다. 환아의 행동특성의 평가는 부모와 학교 담임교사가 각각 부모용 및 교사용의 한국형 아동행동조사표를 작성하였고 환아의 집중력 검사는 T.O.V.A.에 의하여 조사하였다. 결과 천식환아군이 성별과 나이를 맞춘 정상대조군에 비하여 한국형 아동행동조사표상 의의있게 높은 행동장애 점수를 보이고 있었다. 천식의 유병기간이 길수록, 혈중 호산구수가 많을수록, 메타콜린부하검사에서 적은 양에 반응할수록 행동조사표상의 점수가 높았다. 알레르기의 가족력과 혈청면역글로블린 E는 행동조사표의 점수와 상관관계가 없었다. 천식의 심각도는 행동조사표의 점수와 통계적으로 유의한 상관관계는 없었으나, 일반적으로 중증의 천식을 가진 환아에서 높게 나타났다. 집중력검사상 정상대조군 아동과 의의있는 차이는 없었다. 연구결과를 종합하면, 천식을 오래 앓을수록, 그리고 천식의 이학적 검사결과상 기도의 과민반응이 심할수록 부모와 교사가 평가하는 아동의 행동상의 문제점이 많음을 시사하고 있었다. Objects : The results of an investigation into the relationship between clinical, physiological, and behavioral factors in 28 children with asthma are reported. Methods : The children were classified into groups according to the duration of asthma, the severity of asthma and the family history of allergy. Estimation of blood eosinophil count, level of serum Ig E, and the Methacholine challenge test were also carried out. Both parents and school teachers completed Child Behavior Checklist (CBCL). T.O.V.A., one of the standardized continuous performance tests, and K-WISC were assessed to evaluate their attentional problem, and to rule out cognitive dysfunction. Results : Though the total scores of CBCL-parent and CBCL-teacher were higher than the age- and sex- matched normal controls, they were not much higher than the scores for psychiatric clinic groups. The results of CBCL rating by both parents and teachers were highly correlated each other, showing reliability of their ratings. Longer the duration of asthma, higher the blood eosinophil count. Less the amount of methacholine in MCT, higher the CBCL scores by both parents and teachers. Conclusion : The results suggest that children with longer duration of asthma and with more hypersensitive airway reaction may have more behavioral problems.

대구광역시 달성군의 비전 및 구현 방향

김문식,박노보,최외출 영남대학교 지역발전연구소 1997 새마을지역개발연구 Vol.21 No.-

This study is to examine the present condition and vision in Dalsung County and to put foward the methods by which its vision can be realized. The future directions towards the realization of vision of Dalsung County are as follows: 1. Dalsung County should be cooperate with Daegu Metropolitan City, the regional government encompassing it, in administrative and planning matters. 2. Residents should be able to participate in making decisions of vision of Dalsung County and their implementation. 3. Collaborative mechanism between citizen and local government should be constructed. 4. The megalopolis city planning system, which can have effects on Dalsung County, should be reconsidered and improved. 5. The regional egoism should be overcome via the constructive framework for the mutual benefits between neighbouring local governments.