[논문]융복합적 비전테라피가 ADHD 경향 아동의 증상과 시지각에 미치는 영향

조형철; 노효련

doi:10.15207/jkcs.2020.11.7.059

융복합적 비전테라피가 ADHD 경향 아동의 증상과 시지각에 미치는 영향
The Effect of Convergence Vision Therapy on Symptoms and Visual Perception in Children with ADHD tendency 원문보기

한국융합학회논문지 = Journal of the Korea Convergence Society, v.11 no.7, 2020년, pp.59 - 71

조형철 (강원대학교 대학원 의학과) , 노효련 (강원대학교 물리치료학과)

초록
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본 연구는 비전테라피가 시각 문제를 가지고 있는 ADHD 경향 아동의 증상과 시지각 기술을 향상시키는지 알아보고자 한다. 본 연구의 대상자는 ADHD 경향이 있는 아동 중 시각적인 문제를 가지고 있는 아동 10명이다. 비전테라피 전·후로 시각 기능 검사, 시지각 운동협응 검사, 시지각 기술 검사, ADHD 평가척도 검사를 실시하였다. 비전테라피는 주 2회, 6개월~1년 동안 실시되었다. 비전테라피 후에 대상자 모두 시각기능의 시력, 입체시, 버전스 범위, 폭주 근점에서 정상 범위에 도달했으며, 시각 기능과 시지각 기술이 향상되었고 ADHD 증상에 대한 점수가 낮아진 것으로 나타났다. 따라서, 비전테라피가 ADHD 경향을 가진 아동들의 증상과 시지각을 개선하고 시각문제를 해결하는데 활용될 수 있는 것으로 보인다.

Abstract ▼ AI-Helper

The purpose of this study is to determine whether vision therapy improves symptom and visual perceptual skills in children with attention deficit hyperactivity disorder tendency who have visual problems. The subjects of this study were 10 children. Before and after vision therapy, the visual function test, developmental test of visual-motor integration, test of visual perceptual skills, and ADHD rating scale test were performed. Vision therapy was conducted twice a week for a period of 6 months to 1 year. After vision therapy, all subjects achieved normal ranges of visual function, sensory fusion, stereoacuity, vergence function, and convergence. The visual function and visual perceptual skill were improved and the score for ADHD symptoms was reduced. Therefore, it seems that vision therapy can be used to improve the symptoms and visual perception of children with ADHD.

주제어

표/그림 (9)

표 Table 1. Major eligibility criteria in children
표 Table 2. General characteristics of subjects (N=10)
표 Table 3. Vision therapy training program
표 Table 4. Vision therapy training program progress
표 Table 5. Major eligibility criteria and Clinical Details of Subjects
표 Table 6. Comparison of normal criteria for visual function before and after vision therapy
표 Table 7. Changes in VMI after vision therapy
표 Table 8. Changes in TVPS-R after vision therapy
표 Table 9. Changes in ADHD score after vision therapy

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문제 정의

Therefore, it plays an important role in enhancing the developmental tasks and academic achievement of children[7,20], and it can cause obstacles even in adulthood. Therefore, this study aims to investigate the improvement in visual perception ability and ADHD symptoms by applying vision therapy to subjects with high scores and visual problems in the ADHD screening test. Through this study, we will learn how to improve the visual function of ADHD children, and at the same time, we will share information about vision therapy.
This study investigates the changes in visual function and visual perception after applying vision therapy to ADHD children with visual perception problems.
This study was conducted among children who have visual problems and ADHD tendency. Based on the results of this study, this study is a preliminary study for the future study, in which the study subjects are sufficiently secured and ADHD children who do not have visual problems form the control group.
Therefore, this study aims to investigate the improvement in visual perception ability and ADHD symptoms by applying vision therapy to subjects with high scores and visual problems in the ADHD screening test. Through this study, we will learn how to improve the visual function of ADHD children, and at the same time, we will share information about vision therapy.

제안 방법

The subjects of this study were children aged 6 to 12 years who had a vision problem and at least 19 points on the ADHD evaluation scale among children diagnosed with ADHD at the hospital. All subjects were evaluated for visual function, and the data were outside the normal range on comparing with the normal standard for children (see Table 1). Subjects were 10 children (males: 8, females: 2, average age: 7 ± 0.
Before performing VFT, if the subject had refractive problems, the test was performed in a state in which the maximum plus to the maximum visual acuity was displayed through the test lens so that the visual function due to the refractive problem did not occur. When it was determined that there was a problem in the reliability of the measurement by attention and perception levels among the subjects, functions, such as AM were not tested.
In the evaluation of vergence dysfunction, nine patients belonging to the exophoria group achieved the normal range after vision therapy, and one esophoria type satisfied Percival's criterion; therefore, the vergence function problem was solved.
In this study, before and after the application of vision therapy, measurements were performed using the Visual Function Test (VFT), Developmental Test of Visual-Motor Integration (VMI), Test of Visual-Perceptual Skills-Revised (TVPS-R), and ADHD evaluation scale test[21-23].
In this study, children with ADHD tendency received a vision therapy program twice a week for 45 minutes to 1 hour, for a period of 6 months to 1 year. The program was conducted in a one-on-one quiet treatment room setting with visual perception training experts.
In this study, it was found that the developmental test of Visual-Motor Integration (VMI) was improved after applying vision therapy. Jung[32] showed similar results as this study, which is that training with the visual perception program was effective for discrimination training on color, shape, location, and size of children with developmental disabilities.
On comparing the visual function of study subjects on the basis of that of normal children, the types of visual problem in the study subjects included 1 of amblyopia, 1 of basic esophoria associated with amblyopia, 1 of divergence excess, and 3 of convergence insufficiency, 2 of amblyopia associated with convergence insufficiency, 1 of basic exophoria, and 1 of convergence insufficiency associated with vertical deviation (see Table 5).
The test is divided into the following seven areas: visual discrimination, visual memory, visual spatial relationships, visual form constancy, visual sequential memory, visual figure ground, and visual closure. In addition to the total visual perceptual skill score, each sub-area score is also provided[26].
VFT was performed by using equipment and tools, including VISUSSCREEN 500 (Carl Zisss Inc, Germany), Worth 4 Dot (Bernel Inc, USA), Prism Bar (Bernel Inc, USA), Polaroid glass device (Carl Zisss Inc, Germany), Polarized Glasses (Bernel Inc, USA), Howell Visual function using phoria card (Cyclopean Design Inc, made in Australia), Titmus fly (Stereo Optical co., Inc USA), Pencil, red-green filter glasses, and Penlight.

대상 데이터

Subjects were 10 children (males: 8, females: 2, average age: 7 ± 0.64 years) without medication therapy and who received vision therapy from specialized institutions located in the metropolitan area August 2017-August 2018 (see Table 2).
In this study, children with ADHD tendency received a vision therapy program twice a week for 45 minutes to 1 hour, for a period of 6 months to 1 year. The program was conducted in a one-on-one quiet treatment room setting with visual perception training experts.
The subjects of this study were children aged 6 to 12 years who had a vision problem and at least 19 points on the ADHD evaluation scale among children diagnosed with ADHD at the hospital. All subjects were evaluated for visual function, and the data were outside the normal range on comparing with the normal standard for children (see Table 1).
VMI consists of a total of 27 items for children from 3 to 13 years. It, is performed in groups or individually, and it is designed to evaluate the degree to which individuals can integrate visual and motor skills reflecting the developmental age differences.

데이터처리

Visual perception changes and ADHD symptoms of children were compared with the normal criteria. To investigate the effectiveness before and after treatment, a non-parametric test, Wilcoxon signed rank test, was performed. SPSS 21.

이론/모형

64 years) without medication therapy and who received vision therapy from specialized institutions located in the metropolitan area August 2017-August 2018 (see Table 2). The data used in this study were based on the clinical data applied with vision therapy. Since the children were underage, we explained the purpose of the study to the guardians and obtained their consent to conduct the study and use the data.

성능/효과

In conclusion, it seems that vision therapy can be used to improve visual perception & symptoms of children with ADHD tendency and visual problems.
In this study, a large proportion of the problems with visual acuity development, sensory fusion, stereoacuity function, and vergence function were satisfied up to normal standards by applying vision therapy to children with visual function problems and ADHD tendency. After applying vision therapy, 4 of amblyopia met the normal criteria; and in the sensory fusion test, the number of suitable persons at distance increased from 2 to 10 and the number of suitable persons near increased from 1 to 10.
In this study, it was found that after vision therapy, all seven sub-areas in TVPS-R were improved, including visual discrimination, visual memory, visual spatial relationships, visual form constancy, visual sequential memory, visual figure ground, and visual closure. Visual discrimination is an item that distinguishes a given picture from other similar pictures, visual memory is an item that remembers all characteristics of a given shape and identifies it from similar forms, visual spatial relationships is an item that identifies pictures in a different direction from the remaining pictures, visual form constancy is an item that looks and identifies a given form even if it is different in size, direction, or hiding, visual sequential memory is an item that remembers a given group of pictures from different groups of pictures, visual figure ground is an item to identify a given picture hidden in another object, and visual closure is an item to identify a picture that matches the given figure when all lines are connected[26].
On comparison of TVPS-R among general children and children with learning problems in previous studies, standard scores were about 100 in 7 sub-areas among general children and about 85 to 91 points in 7 sub-areas among children with learning problems. In this study, the average standard score was 84.50 ~ 104.90 in the seven sub-areas of TVPS-R, showing a lower score than that in normal children and a similar or slightly higher score than that in children with learning problems.
In this study, there was a remarkable change in the ADHD evaluation scale score after applying vision therapy to children with ADHD tendency and visual function problems, and visual function was also improved. On the other hand, Yang, Lee, and Jeong[43] reported that when diagnosing ADHD symptoms in domestic adolescents, it would be helpful to understand the symptoms by distinguishing hyperactivity symptoms and impulsive symptoms rather than considering the number of corresponding symptoms among the diagnostic criteria.
Before performing VFT, if the subject had refractive problems, the test was performed in a state in which the maximum plus to the maximum visual acuity was displayed through the test lens so that the visual function due to the refractive problem did not occur. When it was determined that there was a problem in the reliability of the measurement by attention and perception levels among the subjects, functions, such as AM were not tested. To ensure the reliability of the measurement in the VFT, perceptual practice was sufficiently performed by the subjects who needed it, and then the average value was recorded after the test was conducted twice or more than two times.

후속연구

This study was conducted among children who have visual problems and ADHD tendency. Based on the results of this study, this study is a preliminary study for the future study, in which the study subjects are sufficiently secured and ADHD children who do not have visual problems form the control group.
Children with a tendency for ADHD without visual problems should be set as the control group and research should be conducted to further secure the number of subjects in the future. In addition, research should be conducted to determine the location where vision therapy affects ADHD trends.

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