지능장애아의 임상적 진단 및 능력평가에 관한 연구

Abstract

[영문]

[한글]

어느시대, 어느지역, 어느종족을 막론하고 지능장애아가 없는 경우는 없다고 하며 그

빈도도 문화권, 종즉 또는 환경에 따라 다양하여 미국의 경우 학동기전 아동의 0.5 %, 학

동기 아동의 1%, 전인구에서 3%에 달한다고 하였으나 우리나라에서는 아직도 지능장애아

의 빈도에 대한 정학한 보고가 없으며 단지 외국의 보고와 유사할 것으로 추정하고 있다.

지능장애아의 정의는 학자마다 다르지만 일반적으로 지능의 발달이 저조하여 학습 및 관

습 습득능력이 없거나 저하되어 있는 아동을 말하며 이들은 본인은 물론 가정과 사회에

정신적, 교육적, 경제적 문제들을 야기시킨다. 지능의 발달은 중추신경계의 발달과 관련

이 있으므로 이들 장애아는 신체적 장애와 신경학적 장애를 흔히 동반하며 장기적인 특수

교육, 훈련 및 의학적인 치료를 요하기도 한다. 따라서 지능장애의 원인을 규명하여 임상

적 진단을 하고, 가능한 원인 제거 및 예방책을 강구하며, 남은 능력을 정확히 평가한 후

그 능력을 효율적인 교육과 훈련을 통해 개발하여 독립적인 개체로 성장할 수 있도록 하

는 것이 가정과 사회에 끼치는 제반 문제를 해결하는 방법이 될수 있다 하겠다.

저자는 1981년 1월부터 1985년 12월까지 5년간 연세대학교 의과대학부속 세브란스병뭔 소

아과에 지능장애를 주소로 내원한 아동 중 GQ가 83이하인 1100명을 대상으로 원인규명,

임상진단 및 능력평가를 실시하여 다음과 같은 결과를 얻었다.

1. 총 1100명중 334명(30.4%)에서 임상적 진단과 원인규명이 불가능하였다. 임상진단이

가능하였던 69.6%는 뇌성마비가 22.5%로 가장 많았으며 소두증(14.6%), 경련성 질환(12.

4%), 염색체 이상증(4.4%)의 순으로 나타났다.

2. 예방이 가능한 질환에 해당하는 341례는 뇌성마비, 염색체이상증, 대사성질환, 내분

비질환 등으로 이들의 예방을 위해 산전관리, 산후 신생아 문제점의 발생방지, 갑상선기

능저하증이나 페닐케톤뇨증에 대한 screening test, 염색체 이상증의 위험이 높은 군에서

임신중 염색체 검사등이 필요하다.

3. Griffiths mental developmental scale에 의해 능력평가를 시행한 결과 96.5%에서

치료, 교육 및 훈련이 필요하였으며 약물치료 428례(38.9%), 물리치료501례(45.5%), 언어

치료 647례(58.8%), 작업치료 670례(60.9%), 특수교육 726례(66.0%)에서 필요하였다.

4. 지능장애아의 종합평가를 위해 각분야의 전문요원들의 공동참여가 필요하며 전문지

식을 집약할 수 있는 기구의 설치운영이 절실히 요구된다.

Studies of clinical diagnosis and evaluation of ability in mentally handicapped

children

Young Hyuk Lee

Department of Medical Science The Graduate School Yonsei University

(Directed by Professor Chang Jun Coe, M.D.)

There ale many diffefent opinions on the definition of mental retardation, but it

is generally accepted that mental retardation is the condition of subnormal general

intellectual abilities or deficits in learning and adaptation in his or her

society.

The prevalence rate is known to be different acoording to race, culture,

environmental status as well as the cultural parameter of measuring the

intelligence. There have been no reports on the incidence and epidemiology of

mental retardation in Korea, but people presumed that the incidence is probably

same as that of other country. According to the report in United States, the

incidence of mentally handicapped children in preschool age is 0.5%, while in

school age the incidence is reported about 1%, some authors insisted that the

incidence of all population is about 3%. Mentally handicapped children provoke not

only the educational, social and economical problems but causes medical and

psychological problems. As mental function is closely rolated with central nervous

system, it often raises neurological problems such as seizure, motor dysfunction or

special sensory organ dysfunction.

The purpose of the medical intervention in assessment are to define the causes of

mental handicap or medical diagnosis and their conditions, to design the

prevention, and helping them by giving medical treatment or assistance such as

hearting aid, brace or medication if required. Secondly all other assessment should

be based on the clinical diagnosis for better evaluation and further training or

educations.

To define the clinical diagnosis and causes of mentally handicapped children in

Korea, 1100 cases of children with mental dysfunction have been medically assessed

at Department of Pediatrics, Yonsei University College of Medicine from January,

1981 through December, 1985.

And we obtained following results;

1. 69.6% out of 1100 children are possible to make a clinical diagnosis as

follow; cerebral palsy(22.5%), microcephaly(14.6%), seizure relating

conditions(12.4%), chromosomal anomalies, metabolic and endocrine disorders,

postcentral nervous system infection, central nervous system anomalies as well as

muscular disorders. Besides, multiple congenital anomialies with unusual looking

face syndrome were detected, postbrain hypoxic damaged children, post-Reye syndrome

and various developmental disorders including childhood autism were detected, The

rest 30.4% of children, the clinical diagnosis or the cause was not clear. They

might be mentally handicapped children undetermined causes or as they were so Young

that the diagnosis or causes are not able determined and requires follow up study

for the diagnosis in certain portion of these children.

2. In 341 cases of 1100 children, their problems might be preventable if they

were properly investigated or received good medical cares by complete antenatal and

perinatal care, by screening test for hypothyroidism, PKU or other metabolic

disorders, or by amniocentesis before the birth.

3. Their abilities were asseased by Griffiths mental developmental scale, Korean

WISC test, visual perception test, visual acuity test and audiogram. 96.5% of them

requires specific and nonspecific medical cares or treatments as well as special

education. The most of children especially requires speech therapy, occupational

therapy and they are socially deprivated.

4. For the exact assessment and evaluation for mentally handicapped children,

well qualified specialists from various fields should make a team to organize an

assessment unit for effective assessment and mutual understanding, exchanging the

concepts. Based on the assessment of various fields the proper education, training,

and medical treatment are able to plan for those handicapped children.

Periodic reassessment is also required for re-evalua-talon of previous assessment

and plan. In case that the education is thought to be ineffective, new educational

or therapeutic plans must be redesigned according to the individual handicapped

child.