Clinical and Experimental Pediatrics

대한소아청소년과학회 (The Korean Pediatric Society)
권호 표지

ASQ :소아과외래에서의 발달지연 선별검사

The ages and stages questionnaire: screening for developmental delay in the setting of a pediatric outpatient clinic

  • 김은영 (가톨릭대학교 의과대학 소아과학교실) ;
  • 성인경 (가톨릭대학교 의과대학 소아과학교실)
  • Kim, Eun Young (Department of Pediatrics, College of Medicine, The Catholic University of Korea) ;
  • Sung, In Kyung (Department of Pediatrics, College of Medicine, The Catholic University of Korea)
  • 투고 : 2007.08.17
  • 심사 : 2007.10.12
  • 발행 : 2007.11.15
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초록

목 적 : 소아의 발달 장애는 조기에 발견하면 조기 치료가 가능하게 되어 치료 효과가 높아지고 후유 장애를 최소화할 수 있다. 발달 장애의 조기 발견을 위하여 기존에 사용해 오던 정식 발달 선별검사는 대부분 시간이 오래 걸리고, 복잡하며, 의료인력이 추가로 필요하기 때문에 바쁜 소아과 외래에서 모든 소아에게 적용하기는 어렵다. 기존의 발달검사 대신에 부모가 작성한 내용을 토대로 평가하는 발달 설문 양식들 중 Ages and Stages Questionnaire (ASQ)는 60개월 이전의 소아의 발달 선별을 목적으로 개발된 검사이다. 본 연구의 목적은 소아과 외래에서 시행하는 발달 지연의 선별 도구로서 ASQ의 타당성을 알아보기 위한 것이다. 방 법 : 가톨릭대학교 의과대학 부속 성모병원 소아과 외래를 방문한 소아의 부모에게 진료 전 대기 시간 동안 한국형 ASQ (K-ASQ)를 완성하도록 하였다. 설문지를 완성한 총 150명 중 만삭 출생아이며 이전에 발달지연의 진단을 받은 적이 없고, 기타 선천성 기형, 경련성 질환을 포함한 신경학적 이상, 유전성 질환의 경력이 없는 소아 67명을 대상으로 하였다. K-ASQ는 각 영역별로 평균에서 2 표준편차(SD) 아래 점수보다 낮으면 "실패"로 판정하며, 한 발달 분야 이상에서 "실패"가 있는 경우를 "선별검사 양성"으로 하였다. 최종 발달평가는 Bayley Scales of Infant Development-II (BSID-II)를 사용하여 판단하였으며, 지능 혹은 운동발달 지수가 평균보다 -1 SD 미만인 경우는 발달지연으로 판정하였다. K-ASQ의 결과를 BSID-II와 비교하여 분석하였다. 결 과 : 1) 대상아의 평균 연령은 $16.4{\pm}7.4$개월($6{\pm}30$개월 범위, 중앙치 14개월)이었다. 10명(14.9%)은 출생 시 부당경량아였으며, 평균 출생체중 $3.1{\pm}0.6kg$, 재태기간 $38.8{\pm}1.4$주이었다. 9명(13.4%)이 쌍생아였고, 33명(49.0%)이 남아였다. 대상 소아들의 모친의 평균 교육 기간은 $13.6{\pm}2.4$년, 53명(79.1%)이 고등학교 졸업 이상의 학력을 가졌고, 21명(31.3%)이 정규직 근무자였다. ASQ 설문지를 완성하는데 평균 $10.2{\pm}3.0$분이 소요되었다. (2) 17명(25.4%)이 ASQ 선별검사 양성이었는데, 그 중 4명은 발달이 지연되었고, 나머지 13명의 발달은 정상이었다. BSID-II로 판정한 발달 지연아 8명 중 4명은 ASQ 선별검사에서 양성이었고, 다른 4명은 선별검사 음성이었다. ASQ 선별검사 음성인 50명 중 4명이 발달지연으로 판단되었다. (3) BSID-II와 비교한 K-ASQ의 민감도(sensitivity)는 50.0%, 특이도(specificity) 78.0%, 양성 예측치 (positive predictive value) 23.5%, 음성 예측치(negative predictive value)는 92.0%로 나타났다. 결 론 : K-ASQ는 높은 음성 예측치를 보여 소아과 외래에서 소아 발달 지연의 선별 도구로서 사용하는 것이 타당한 것으로 판단되었다.

Purpose : Early identification of developmental disabilities allows intervention at the earliest possible point to improve the developmental potential. The Ages and Stages Questionnaire (ASQ), a parent- completed questionnaire, can be used as a substitute for formal screening tests. The purpose of this study was to evaluate the validity of the Korean version of the ASQ (K-ASQ) as a screening tool for detecting developmental delay of young Korean children in the setting of a busy pediatric outpatient clinic. Methods : Parents completed the K-ASQ in the waiting room of the pediatric outpatient clinic of St. Mary's Hospital, Catholic University Medical College. Out of 150 completed the ASQ, 67 who were born term and had no previous diagnosis of developmental delay, congenital anomalies, or neurological abnormalities were enrolled. The cut-off values of less than 2 standard deviations (SD) below the mean for the ASQ were used to define a "fail", and children who failed in one or more domains tested were classified as "screen-positive". Diagnosis of developmental delay was made when the developmental indices fell below -1 SD of the Bayley Scales of Infant Development-II. Results : (1) The mean age of children was $16.4{\pm}7.4$ months. Ten children (14.9%) were small-for- gestational age infants. The mean birth weight and gestational age were $3.1{\pm}0.6kg$ and $38.8{\pm}1.4$ weeks. Nine children (13.4%) were twins and 33 (49.0%) were male. The mean maternal education in years was $13.6{\pm}2.4$, and 31.3% had full-time jobs. The time for completing the ASQ was $10.2{\pm}3.0$ minutes. (2) Seventeen children (25.4%) were classified as screen-positive, four of them were delayed in development. Among eight children diagnosed with developmental delay, four were screen-positive and the other four were screen-negative by the ASQ. (3) The test characteristics of the ASQ were as follows: sensitivity (50.0%); specificity (78.0%); positive predictive value (23.5%); negative predictive value (92.0%). Conclusion : The high negative predictive value of the K-ASQ supports its use as a screening tool for developmental delay in the setting of a pediatric outpatient clinic.

키워드

과제정보

연구 과제 주관 기관 : 가톨릭중앙의료원

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