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제목: 우리 아이, 다른 것은 괜찮은데 말을 하는데 어려움이 있어요. - 의사소통 장애 ②
글쓴이: 날짜: 2014.11.24 11:29:51 조회:2589 추천:0 글쓴이IP:118.36.227.111
파일:     첨부파일이 없습니다.
 

Q. 우리 아이, 다른 것은 괜찮은데 말을 하는데 어려움이 있어요.

 

A. 정상적인 지능 수준에도 의사소통에 사용되는 말이나 언어 사용에 결함이 있는 경우 의사소통 장애(Communication Disorder)일 수 있습니다.

 

의사소통 장애는 다음의 4가지 유형이 있습니다.

* 언어장애 / 발화음 장애 / 아동기-발생 유창성 장애 / 사회적 의사소통 장애

 

3. 아동기-발생 유창성 장애

 

아동기-발생 유창성 장애(Childhood-Onset Fluency Disorder)는 말더듬기로 인해서 언어의 유창성에 어려움이 있는 경우를 말합니다. 말더듬기는 말을 시작할 때 ---난 기분이 좋다,”와 같이 첫 음이나 음절을 반복하여 사용하거나, “나는 하~악교에 간다.”처럼 특정한 발음을 길게 하거나 또는 말을 하는 도중에 부적절하게 머뭇거리거나 갑자기 큰 소리로 발음하는 등 다양한 형태로 나타납니다. 말더듬기를 지닌 아동은 발음하기 어려운 단어를 피하기 위해 다른 단어로 바꿔 말하거나 넌지시 돌려서 말하기도 합니다. 때로 어떤 단어를 말할 때 신체적으로 과도하게 긴장된 모습을 나타내기도 하며, 이러한 장애의 증상들은 초기 아동기에 시작됩니다.

 

말더듬기의 정도는 상황에 따라 다양하게 나타날 수 있습니다. 말을 해야 하는 특별한 압력이 있는 경우에는 말더듬기가 더 심해지는 반면, 노래를 하거나 애완동물과 이야기할 때는 더듬지 않기도 합니다. 일반적으로 말더듬기는 스트레스나 불안으로 인하여 악화되며, ‘눈 깜박거림, , 입술이나 안면의 떨림, 머리를 갑자기 움직이기, 숨쉬기, 주먹 쥐기등의 특정한 동작이 동반되기도 합니다. 아울러 말더듬기가 있는 아동은 또래 아동으로부터 놀림의 대상이 되므로 말더듬기에 대한 두려움을 지니게 되며, 말을 하지 않거나 말하는 상황을 회피하게 됩니다. 사회적 관계에서도 말더듬기로 인해 좌절감과 불안은 경험하게 되고, 낮은 자존감과 사회적 위축을 가져올 수 있으며 성인의 경우 직업 선택이나 승진에 어려움을 겪게 됩니다.

 

말더듬기는 전형적으로 2~7세에 점진적으로 발생하는데, 논에 띄지 않는 가벼운 말더듬기가 보통 몇 개월에 걸쳐 현저한 말더듬기로 발전하게 됩니다. 일반적으로 말더듬기는 단어의 첫음절이나 구절의 첫 단어를 반복하면서 점진적으로 시작되는데, 악화와 호전을 반복하면서 더듬는 단어가 점점 확대됩니다. 그러나 말을 더듬는 아동의 약 60%정도는 자연적으로 회복되는데 대부분 16세 이전에 회복됩니다.

 

말더듬기의 원인은 명확하게 밝혀진 것이 없으나 다양한 요인이 관여하는 것으로 알려져 있습니다. 흔히 말을 더듬는 사람을 흉내 내거나 정서적으로 흥분되고 불안한 상태에서 우연히 말을 더듬게 되면서 말더듬기가 시작됩니다. 또는 심리적 압박을 느끼거나 긴장감이 높아져서 자연스러운 발과 행동이 억제되는 상황에서 시작되기도 합니다. 이렇게 시작된 말더듬기가 반복되면서 점차 증상이 악화되고, 스스로 통제하기 어려운 심한 말더듬기의 상태로 발전하게 됩니다. 그리고 다른 사람 앞에서 말을 더듬는 것에 대한 불안과 두려움으로 인하여 심리적, 신체적 긴장이 커지기 때문에 악화되기도 하며, 말하는 상황을 회피하게 되므로 말더듬기를 교정할 수 있는 기회를 갖지 못하여 증상이 지속됩니다.

 

말더듬기의 치료는 개인이 나타내는 증상과 심리적 특성을 고려하여 이루어져야 합니다. 우선 개인이 어려움을 겪는 말더듬기 행도의 정밀한 평가와 분석이 이루어져야 하며, 말더듬기가 악화되는 상황과 그에 관련되는 심리적 요인에 대한 분석이 이루어진 후에 적절한 치료가 진행되어야 합니다.

 

말더듬기에는 인지행동적 치료언어치료적 훈련이 도움이 됩니다.

 

먼저 인지행동적 치료에서는 자신의 말더듬기를 수용하고 타인에게 자신의 여려움을 알려주어 대화 상황에서 불안과 긴장이 감소하게 되어 말더듬기를 개선되게 하거나 사회적 상황에서 과도하게 느끼는 불안과 공포를 완화시키는 것을 통해 말더듬기를 개선합니다.

 

언어치료적 훈련에서는 더듬게 되는 음절이나 단어에 대한 유창한 발성 연습, 정확한 발음을 위한 호흡조절능력의 향상, 리듬을 타면서 말을 하는 연습 등의 훈련이 이루어집니다.

 

이러한 인지행동적 치료와 언어치료적 훈련은 함께 이루어지는 것이 바람직하며, 실제 대화상황으로의 점진적인 노출을 통해 올바른 발음과 언어를 사용하도록 유도하고 격려하는 것이 필요합니다.

 

4. 사회적 의사소통 장애

 

사회적 의사소통 장애(Social Communication Disorder)는 언어적·비언어적 의사소통 기술의 사회적 사용에 지속적인 어려움을 나타내는 경우를 말합니다.

 

이러한 의사소통 기술의 사회적 활용은 다음과 같습니다.

 

(1) 인사하거나 정보 교환과 같은 사회적 목적을 위해 상황에 적절하게 의사소통 하는 능력

(2) 상황이나 듣는 사람의 필요에 맞추어 의사소통을 적절하게 변화시키는 능력

(: 놀이할 때와 교실에서 달리 말하기, 아이와 어른에게 달리 말하기)

(3) 대화, 이야기하기에서 규칙을 따르는 능력

(: 대화에서 번갈아 말하는 것, 잘 이해하지 못했을 때 되묻기)

(4) 명시적으로 표현되지 않은 것이나 언어의 함축적이거나 이중적 의미를 이해하는 능력

 

이러한 네 가지 기능 모두에서 어려움을 나타내어 사회적 적응에 현저한 지장이 초래되는 경우에 사회적 의사소통 장애로 진단되게 되며, 초기 아동기에 시작됩니다.

 

 

 

참고문헌: 현대이상심리학 2, 권석만 저, 학지사

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