말 언어 지연을 보인 소아에서 원인에 따른 말 언어 치료의 효과

The Efficacy of Speech and Language Therapy for Children with Speech and Language Delays according to the Eiologies

  • 김준범 (가톨릭대학교 의과대학 소아과학교실) ;
  • 서진순 (가톨릭대학교 의과대학 소아과학교실) ;
  • 김영훈 (가톨릭대학교 의과대학 소아과학교실) ;
  • 정승연 (가톨릭대학교 의과대학 소아과학교실) ;
  • 이인구 (가톨릭대학교 의과대학 소아과학교실) ;
  • 황경태 (가톨릭대학교 의과대학 소아과학교실) ;
  • 이병철 (가톨릭대학교 의과대학 소아과학교실)
  • Kim, June Bum (Department of Pediatrics, College of Medicine, The Catholic University of Korea) ;
  • Suh, Jin-Soon (Department of Pediatrics, College of Medicine, The Catholic University of Korea) ;
  • Kim, Young-Hoon (Department of Pediatrics, College of Medicine, The Catholic University of Korea) ;
  • Chung, Seung-Yun (Department of Pediatrics, College of Medicine, The Catholic University of Korea) ;
  • Lee, In-Goo (Department of Pediatrics, College of Medicine, The Catholic University of Korea) ;
  • Whang, Kyung-Tai (Department of Pediatrics, College of Medicine, The Catholic University of Korea) ;
  • Lee, Byung-Churl (Department of Pediatrics, College of Medicine, The Catholic University of Korea)
  • 투고 : 2005.04.18
  • 심사 : 2005.06.23
  • 발행 : 2005.09.15

초록

목 적 : 최근에 말 언어 지연 소아의 치료효과에 대해서는 논란의 여지가 있다. 본 연구는 말 언어 지연을 보인 소아의 임상적인 특징과 6개월 동안의 언어 치료 후 원인질환에 따른 예후를 알아보고자 시도하였다. 방 법 : 2000년 1월부터 2004년 3월까지 가톨릭대학교 의정부 성모병원 소아과에 말 언어 지연을 보여 내원한 환아 중 6개월 동안 말 언어 치료를 받은 56명의 소아를 대상으로 후향적으로 조사하였다. 결 과 : 대상 환아 56명의 질환별 분포는 발달성 언어 장애가 66.1%로 가장 많았고 구조적 이상 19.6%, 정신 지체 12.5%, 청력 이상 1.8% 순이었다. 남녀 비는 4.6 : 1이었으며, 환아의 연령별 분포는 47개월 이상이 가장 많았다. 의미 있는 첫 단어의 평균 출현 시기는 15.9개월이었다. 평균 재태기간은 39.8주로 만삭아 96.4%, 미숙아 3.6%으로 만삭아가 많았다. 형제 순서는 첫째 51.8%, 둘째 24명, 셋째 7.1%으로 첫째가 가장 많았다. 6개월간의 언어 치료 후 추적 검사 결과, 발달성 언어 장애아의 경우 32.4%가 정상적인 언어 발달을 보였다. 정신 지체의 경우 추적검사 결과 모두에서 언어 지연이 지속되었다. 구조적 이상 11명 중 5명이 정상적인 언어 발달을 보였다. 결 론 : 언어 지연을 주소로 내원한 소아의 연령이 늦은 것은 이 지역 언어 지연 소아를 대상으로 한 언어 발달 선별 검사가 필요함을 시사하는 것이다.

Purpose : Treatment efficacy for children with speech and language delay has been the subject of considerable debate in recent years. We evaluated the clinical features of children with delayed speech and language and their prognoses according to their etiologies after 6 months of speech and language therapy. Methods : From January, 2000 to March, 2004, we retrospectively reviewed 56 children with speech and language delay who were administered speech and language therapy for 6 months in Uijongbu St. Mary's Hospital. Results : Of 56 cases, the proportion of developmental language disorder was 66.1 percent, structural malformation 19.6 percent, mental retardation 12.5 percent, hearing defect 1.8 percent. The ratio of male to female was 4.6 : 1 and the most frequent age group was over 47 months. The mean age of first spontaneous words with useful meaning was 15.9 months. The mean gestational age of the subjects was 39.8 weeks. The proportion of full-term infants was 96.4 percent and of premature infants was 3.6 percent. As for the birth order, the proportion of the first baby was 51.8 percent, the one of second babies it was 42.9 percent, and percent of third babies it was 7.1 percent. After 6 months of language intervention, 32.4 percent of patients with developmental language disorder showed normal linguistic development. All the patients with mental retardation showed sustained language and speech delay. As for the patients with structural malformations, five out of 11 patients showed normal linguistic development. Conclusion : The relatively advanced old age of majority of participants in this study suggests the necessity of screening test for language delay in this local community.

키워드

참고문헌

  1. Law J, Garrett Z, Nye C. The efficacy of treatment for children with developmental speech and language delay/ disorder : a meta-analysis. J Speech Lang Hear Res 2004; 47:924-43 https://doi.org/10.1044/1092-4388(2004/069)
  2. Tomblin JB, Smith E, Zhang X. Epidemiology of specific language impairment : Prenatal and perinatal risk factors. J Commun Disord 1997;30:325-44 https://doi.org/10.1016/S0021-9924(97)00015-4
  3. Robinson RJ. Causes and associations of severe and persistent specific speech and language disorders in children. Devel Med Child Neurol 1991;33:943-62 https://doi.org/10.1111/j.1469-8749.1991.tb14811.x
  4. Kripke C. Therapy for speech and language delay. Am Fam Physician 2004;69:2823-4
  5. Plante E. Criteria for SLI : The Stark and Tallal legacy and beyond. J Speech Lang Hear Res 1998;41:951-7
  6. Ludlow CL. Children's language disorders : recent research advances. Ann Neurol 1980;7:497-507 https://doi.org/10.1002/ana.410070602
  7. Silva PA. The prevalence, stability and significance of developmental language delay in preschool children. Devel Med Child Neurol 1980;22:768-77 https://doi.org/10.1111/j.1469-8749.1980.tb03743.x
  8. Law J, Conti-Ramsden G. Treating children with speech and language impairments. BMJ 2000;321:908-9 https://doi.org/10.1136/bmj.321.7266.908
  9. Gibbard D, Coglan L, MacDonald J. Cost-effectiveness analysis of current practice and parent intervention for children under 3 years presenting with expressive language delay. Int J Lang Commun Disord 2004;39:229-44 https://doi.org/10.1080/13682820310001618839
  10. American Psychiatric Association. Diagnostic and statistical manual of mental disorder. 4th ed. Washington : American Psychiatric Associaton, 2000
  11. Harel S, Greenstein Y, Kramer U, Yifat R, Samuel E, Nevo Y, et al. Clinical characteristics of children referred to a child development center for evaluation of speech, language and communication disorders. Pediatr Neurol 1996;15: 305-11 https://doi.org/10.1016/S0887-8994(96)00222-6
  12. Lee K. Children with delayed speech development. Korean J Pediatr 1992;35:1236-42
  13. Shriberg LD, Tomblin JB, McSweeny JL. Prevalence of speech delay in 6-year-old children and comorbidity with language impairment. J Speech Lang Hear Res 1999;42: 1461-81
  14. Silva PA, Williams S, McGee R. A longitudinal study of children with developmental language delay at age three: later intelligence, reading and behaviour problems. Devel Med Child Neurol 1987;29:630-40 https://doi.org/10.1111/j.1469-8749.1987.tb08505.x
  15. Yew JH, Kim YD, Lee KS. The study for causes of childhood language disorders. J Korean Child Neurol Soc 2004;2:85-91
  16. Coplan J, Gleason JR. Unclear speech : Recognition and significance of unintelligible speech in preschool children. Pediatrics 1988;82:447-52
  17. Solomons G. Prevalence of speech and hearing problems in a child development clinic population. Clin Pediatr 1970;9: 384-9 https://doi.org/10.1177/000992287000900706
  18. Stevenson J, Richman N. The prevalence of language delay in a population of three year-old children and its association with general retardation. Devel Med Child Neurol 1976; 18:431-41 https://doi.org/10.1111/j.1469-8749.1976.tb03682.x
  19. Kim SJ, Kim YH, Lee YK, Kim DU, Han SH, Chung SY, et al. The clinical features of children with developmental language disorder. J Korean Child Neurol Soc 2001;9:122-8
  20. Largo RH, Molinari L, Comenale Pinto L, Weber M, Duc G. Language development of term and preterm children during the first five years of life. Dev Med Child Neurol 1986;28:333-50 https://doi.org/10.1111/j.1469-8749.1986.tb03882.x
  21. Coplan J, Gleason JR, Ryan R, Burke MG, Williams ML. Validation of an early language milestone scale in a highrisk population. Pediatrics 1982;70:677-83
  22. Lee K. Language development in first 3 years of life and early language screening scale. J Korean Pediatr Soc 1991; 34:465-73
  23. Tomblin JB. The effect of birth order on the occurrence of developmental language impairment. Br J Disord Commun 1990;25:77-84. https://doi.org/10.3109/13682829009011964
  24. Glogowska M, Roulstone S, Enderby P, Peters TJ. Randomised controlled trial of community based speech and language therapy for preschool children. BMJ 2000;321:923- 26. https://doi.org/10.1136/bmj.321.7266.923
  25. Whitehurst GJ, Fischel JE. Practitioner review : early developmental language delay : what, if anything, should the clinician do about it? J Child Psychol Psychiatry 1994;35: 613-48 https://doi.org/10.1111/j.1469-7610.1994.tb01210.x
  26. McRae KM, Vickar E. Simple developmental speech delay : a follow-up study. Dev Med Child Neurol 1991;33:868-74 https://doi.org/10.1111/j.1469-8749.1991.tb14795.x