[논문]ADHD 아동의 유형별 시각 기능의 문제 발생률에 대한 융복합적 접근

조형철; 노효련

doi:10.15207/jkcs.2021.12.2.113

ADHD 아동의 유형별 시각 기능의 문제 발생률에 대한 융복합적 접근
Convergence Approach to the Incidence of Visual Function Problems by the Type of ADHD in Children 원문보기

한국융합학회논문지 = Journal of the Korea Convergence Society, v.12 no.2, 2021년, pp.113 - 120

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

초록
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본 연구는 시각적인 장애를 호소하는 ADHD로 진단받은 아동의 유형별 시각 기능의 특징을 확인하고자 하였다. 연구 대상자는 ADHD로 진단받은 아동 49명으로 시각기능이 정상범위에서 벗어난 경우이다. Korean-ADHD Rating Scale을 이용하여 ADHD 유형을 알아보았고 시각기능 검사를 통해 시각 기능의 문제를 알아보았다. 시각의 문제를 가지고 있는 ADHD 아동들은 부주의 유형(69.4%)이 가장 많았으며 시력은 좋지만 시각 기능 문제가 드러난 경우도 50% 정도 되었다. 주의력결핍 유형에서 근시 관련 시각장애, 과잉활동형 유형에서 난시 관련된 시각장애가 높게 나타났다. 버전스 기능 장애에서는 폭주부족이 가장 많았으며 유형별 차이는 나타나지 않았다. ADHD 아동의 유형별 시각장애의 특성은 차이가 나타나므로 시각 기능 장애의 검사와 선별을 통해 아동의 문제행동에 접근하는 것이 필요하다.

Abstract ▼ AI-Helper

The objective of this study is to identify the visual function impairment of children with each type of attention deficit hyperactivity disorder(ADHD). The subjects of this study were 49 children diagnosed with ADHD with visual function out of the normal range. The type of ADHD was investigated using the Korean-ADHD Rating Scale and visual function test. The attention deficit type(69.4%) of ADHD was the most common type among children with ADHD with vision problems. Although their overall naked-eye visual acuity was good, about 50% of the subjects showed problems with visual function. For those with the attention deficit type of ADHD, the myopia-related refractive error was high. For those with the hyperactivity type of ADHD, the astigmatism-related refractive error was higher. For those with vergence function disorder, convergence insufficiency was the most common. As there were differences in the visual impairment characteristics of children with different types of ADHD, it is necessary to approach a child's problem behavior through examination and screening for visual function disorders.

주제어

표/그림 (5)

표 Table 1. General characteristics of the subjects (M±SD)
표 Table 2. Types of ADHD n(%)
$Table 3. Types of ADHD and refraction types in the children n(%)$ 표 Table 3. Types of ADHD and refraction types in the children n(%)
표 Table 4. Types of ADHD in children and the strabismus incidence rate n(%)
표 Table 5. Vergence anomalies n(%)

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문제 정의

In this study, among children diagnosed with ADHD, we tried to determine the characteristics of their visual function problems according to each type of ADHD. Some meaningful results were drawn and the conclusions based on these findings are as follows.
Second, there will be problems with visual function characteristic of ADHD children with visual impairment. The aim of this study was to identify the visual function problems of children with each type of ADHD who also had a visual impairment. Whether visual function might affect the behavioral characteristics of children with ADHD was also investigated based on this result.
This study attempted to understand the characteristics of visual function by the type of ADHD in children. As there were differences in the characteristics of visual impairment according to the type of ADHD in the children, research on the relationship between the characteristics of visual impairment and the behavioral characteris -tics of children with ADHD is needed in the future.

제안 방법

Before performing the VFT, if the subject had a refraction problem, the test was performed in a state where maximum plus to maximum visual acuity was generated through the test lens so that the visual function due to the refraction problem was not affected. After sufficient practice was given to the subjects to ensure the reliability of the VFT measurement, the mean value was measured and recorded by performing two or more tests.
All statistical analyses were performed using SPSS 21.0 for Windows to investigate visual problems in the children according to the type of ADHD. Descriptive statistical analysis was performed for the children's general characteris -tics and scores by type of ADHD.
Those with mental retardation (MR) were excluded. All study subjects were evaluated for visual function. Their data were compared with those of normal children and were out of the normal ranges.
The VFT included visual acuity, distance sensory fusion (Worth 4 Dot), distance/near stereo-acuity, distance/near phoria, the alternate prism cover test(ACT), and an assessment of the distance/near vergence range. Before performing the VFT, if the subject had a refraction problem, the test was performed in a state where maximum plus to maximum visual acuity was generated through the test lens so that the visual function due to the refraction problem was not affected. After sufficient practice was given to the subjects to ensure the reliability of the VFT measurement, the mean value was measured and recorded by performing two or more tests.
0 for Windows to investigate visual problems in the children according to the type of ADHD. Descriptive statistical analysis was performed for the children's general characteris -tics and scores by type of ADHD. The Chi squared test was performed for the types of ADHD, refraction type, and binocular dysfunction types, non-strabismus, strabismus.
, USA), a pencil, red- green filter glasses, and a penlight. The VFT included visual acuity, distance sensory fusion (Worth 4 Dot), distance/near stereo-acuity, distance/near phoria, the alternate prism cover test(ACT), and an assessment of the distance/near vergence range. Before performing the VFT, if the subject had a refraction problem, the test was performed in a state where maximum plus to maximum visual acuity was generated through the test lens so that the visual function due to the refraction problem was not affected.
subjects. The VFT was performed using the following measurement equipment and tools: the VISUSSCREEN 500 (Carl Zisss Inc., Germany), the Worth 4 Dot (Bernel Inc., USA), a prism bar (Bernel Inc., USA), Polaroid glasses device (Carl Zisss Inc., Germany), polarized glasses (Bernel Inc., USA), a Howell phoria card (Cyclopean Design Inc., Australia), a Titmus fly (Stereo Optical co., Inc., USA), a pencil, red- green filter glasses, and a penlight. The VFT included visual acuity, distance sensory fusion (Worth 4 Dot), distance/near stereo-acuity, distance/near phoria, the alternate prism cover test(ACT), and an assessment of the distance/near vergence range.
Each question was evaluated on a 4-point scale: at all or not(0 points), sometimes (1 point), often(2 points), and very often(3 points). The odd-numbered items on the scale were configured to respond to attention deficit and the even-numbered items were configured to respond to hyperactivity-impulsive symptoms. The total score of the odd-numbered questions was used to measure attention deficit symptoms while the total score of the even-numbered questions was used to measure hyperactivity-impulsive symptoms.
DSM-IV[9]. The purpose of the evaluation scale was to collect information on the frequency of problematic behavior from parents or teachers and use them for ADHD diagnosis and treatment in clinical settings. The evaluation scale consisted of a total of 18 questions and was conducted by parents or teachers.
The total score of the odd-numbered questions was used to measure attention deficit symptoms while the total score of the even-numbered questions was used to measure hyperactivity-impulsive symptoms. The total score of all questions was used to measure ADHD. According to Kim et al.

대상 데이터

The purpose of the evaluation scale was to collect information on the frequency of problematic behavior from parents or teachers and use them for ADHD diagnosis and treatment in clinical settings. The evaluation scale consisted of a total of 18 questions and was conducted by parents or teachers. Each question was evaluated on a 4-point scale: at all or not(0 points), sometimes (1 point), often(2 points), and very often(3 points).
The subjects of this study were 6 to 13-year-old children diagnosed with ADHD. Those with mental retardation (MR) were excluded.

성능/효과

The types of ADHD in female children included an inattention type in two subjects, an hyperactivity type in one subject, and a equal type in one subject. Among all subjects of the study, the inattention type (n = 34) was the most common ADHD type, followed by the hyperactivity type (n = 10) and the equal type (n = 5).
First, about 50% of the children with ADHD who had visual function problems showed normal levels of naked-eye visual acuity. This aspect confirms that if the visual acuity of a child with ADHD is good, the vision problem should not be considered to be resolved.
Fourth, CI had the highest incidence in those with vergence function disorder, showing no difference between ADHD types. Therefore, there will be a lot of problems that the eyes cannot focus on.
In this study, 51.0% of the children with ADHD with visual impairment had normal refraction, whereas about half of them had abnormal refraction. Therefore, even in children with ADHD who had visual problems, about half of them did not have visual refraction problems (that is, visual acuity problems).
In this study, CI was the highest in children with ADHD with visual impairment. In particular, the CI was high at 28.
In this study, among the ADHD subtypes, the inattention type was the most common one at 69.4%, followed by the hyperactivity type (20.4%), and the equal type (10.2%). In a study by Byun et al.
In this study, in children with the inattention type of ADHD, intermittent exotropia accounted for 12.2% and esotropia accounted for 2.0%. However, intermittent exotropia accounted for only 4.

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