Shinyoung Kim, et al. Working Memory Intervention for Children with Delay in Vocabulary Development 단순언어장애아동의언어문제는의미, 구문및형태, 화용론등언어영역전반에다양하게나타나지만, 특히제

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1 ISSN (Print) ISSN (Online) Commun Sci Disord 2015;20(4): Original Article Study of Working Memory Intervention in Children with Delay in Vocabulary Development: Effects on Working Memory and Language Ability Shinyoung Kim, Dongsun Yim Department of Communication Disorders, Ewha Womans University, Seoul, Korea Correspondence: Dongsun Yim, PhD Department of Communication Disorders, Ewha Womans University, 52 Ewhayeodae-gil, Seodamun-gu, Seoul 03760, Korea Tel: Fax: Received: October 4, 2015 Revised: November 10, 2015 Accepted: November 21, 2015 This work was supported by the National Research Foundation of Korea Grant funded by the Korean government (NRF-2014S1A5A ). Objectives: Studies have carried out the base of the processing mechanism regarding language problems of children with language impairments, focusing on working memory. The purpose of this study was to examine the effects of intervention aimed at activating working memory in children with delay in vocabulary development (VD) and the subsequent effect on working memory and language ability. Methods: A total of 12 children (6 children with VD and 6 typically developing children [TD] matched by chronological age) age 5-7 were assessed through working memory tasks. Pre-post design was used to compare differences among working memory tasks (nonword repetition, Competing Language Processing Task [CLPT], and matrix) and language tasks (Receptive & Expressive Vocabulary Test [REVT], Korean-Token Test for Children [K-TTFC], sentence repetition, and grammaticality judgment) in the VD group. Children with VD were provided with intensive intervention sessions 3 times a week for 5 weeks. Results: The research found that the VD group showed lower performance than the TD group in working memory tasks. After intervention for activating working memory, the children with VD showed improvement in one of the working memory tasks (CLPT-word recall) and several language tasks (REVT, K-TTFC, sentence repetition, reaction time for grammaticality judgment). Conclusion: Working memory intervention resulted in increased working memory capacity, improved vocabulary (REVT), auditory comprehension of language and attention (K-TTFC), and syntactic ability (sentence repetition, and grammaticality judgment). Therefore, intervention for working memory has a positive effect on not only working memory capacity but language ability as well. Keywords: Working memory, Working memory intervention, Delay in vocabulary development, Language impairment, Language ability 언어는의사소통의수단이되는사회적도구로써, 정상적인언어발달은학업적성취와사회적성공에있어서도중요한요소이다. 단순언어장애 (specific language impairment) 는일반적으로인지, 청력, 기타신경학적결함없이발현되는발달적언어장애를말하는데 (Stark & Tallal, 1981), 선행연구들에따르면단순언어장애아동은어휘발달이또래에비해늦으며 (Kail, Hale, Leonard, & Nippold, 1984; Lahey & Edwards, 1999; Leonard, Nippold, Kail, & Hale, 1983; McGregor & Windsor, 1996), 문법형태소사용에제한을보이고 (Bortolini, Caselli, & Leonard, 1997; Leonard, 1989; Rice & Oetting, 1993), 구문영역에있어서도평균발화길이가짧고다양한구문구조의사용에어려움을보이는등또래에비해발달이느린특징을보인다 (Kim & Pae, 2002; Lee, Kim, & Yun, 2008; Leonard, McGregor, & Allen, 1992; Morehead & Ingram, 1973). 단순언어장애아동들은언어발달초기부터이러한특징들을보이곤하며, 학령기에접어들면서언어를기반으로하는학습전반에결함을가져옴에따라읽기장애와학습장애로까지연결 (Bishop & Adams, 1990; Rescorla, 2002) 되기도한다는점에서정확한평가와조기중재가중요하다. Copyright 2015 Korean Academy of Speech-Language Pathology and Audiology This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( by-nc/3.0) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited

2 Shinyoung Kim, et al. Working Memory Intervention for Children with Delay in Vocabulary Development 단순언어장애아동의언어문제는의미, 구문및형태, 화용론등언어영역전반에다양하게나타나지만, 특히제한된어휘발달은단순언어장애아동에게서나타나는대표적인지표인것으로많은선행연구들이지목하였다 (Adams & Gathercole, 1995; Leonard, 1998; Leonard, Camarata, Rowan, & Chapman, 1982; Montgomery, 1995; Oetting, Rice, & Swank, 1995; Rice, Cleave, & Oetting, 2000). 특히낱말찾기장애 (word-finding deficit) 는단순언어장애아동의어휘적특성과관련하여가장많이보고되고있는것중의하나로서, 어떤상황이나자극에대해특정낱말을산출하는데어려움을갖는것을말한다. 낱말찾기는이름대기 (naming) 과제를통하여평가할수있는데, 단순언어장애아동은일반아동에비해이름대기과제의수행력이유의하게낮았음을보고한선행연구들이있다 (Fried- Oken, 1987; Kail et al., 1984; Leonard et al., 1983; Lee & Kim, 2002, 2003; McGregor & Windsor, 1996; McGregor, 1997; McGregor & Appel, 2002). 단순언어장애아동들은제한된어휘를사용하고짧고단순한구문을산출하며문법형태소를적절히사용하지못하는구문오류를보이는등, 언어의다른영역보다특히구문및형태론영역의발달이느린것으로알려져있다 (Paul, 1993; Rescorla, Roberts, & Dahlsgaard, 1997; Steckol & Leonard, 1979). 문장따라말하기는구문능력과높은상관관계가있으며 (Hale-Haniff & Siegel, 1981; Schwartz & Daly, 1976), 아동의문법지식을반영하는과제이다. 선행연구에의하면구문발달이늦거나구문결함을보이는아동들은문장따라말하기과제를수행할때자신의문법지식에있지않은구문의경우에는어순을바꾸어문장을산출하거나문법형태소를표현하는데어려움을보이는경우가많다 (Kim & Chung, 2011). 또한단순언어장애아동의문장따라말하기수행력이일반아동에비해유의하게낮으며 (An & Kim, 2000; Menyuk & Looney, 1972), 문장따라말하기과제를수행할때중요한문법표지나음운규칙을처리하고어휘를음운규칙에맞추어정확하게회상산출하는데있어서어려움을보임을밝힌선행연구결과들이있다 (Briscoe, Bishop, & Norbury, 2001; Eadie, Fey, Douglas, & Parsons, 2002). 단순언어장애아동은일반아동에비해언어의전반적인영역에서지체를보이나, 특히문법적인측면의제한이두드러진다는것이많은연구들에서보고되었다 (Bishop, 1994; Cleave & Rice, 1997; Leonard, 1998; Rice & Oetting, 1993). 단순언어장애아동들은생활연령이비슷한일반아동뿐만아니라언어연령이비슷한나이가더어린아동에비하여서도미숙한모습을보인다고보고되었으며 (Rice, Wexler, & Hershberger, 1998; Rice, Wexler, & Redmond, 1999), 국내의선행연구에서도단순언어장애아동의문법형태소 산출이생활연령을일치시킨일반아동과비교하여지체되었음을보인바있다 (Jeong & Hwang, 2007; Jung & Pae, 2010). 선행연구에서문법적으로오류가있는문장을판별하게하는문법성판단 (grammaticality judgment) 과제로문법능력을평가한결과, 단순언어장애아동은또래일반아동에비하여정확도와반응시간에서모두낮은수행력을보였으며 (Edwards & Kirkpatrick, 1999; Wulfeck, 1993), 국내연구에서도단순언어장애아동이또래일반아동에비하여조사오류에대한판단의정확도가낮은것으로나타났다 (Jeong & Hwang, 2007; Jung & Pae, 2010). 이와같이단순언어장애아동에대한연구는초기에는주로어휘, 구문, 형태론적측면등언어의각영역에서의결함에관심을갖고이를규명하고자하였다 (Leonard, 1998). 즉, 단순언어장애아동이주로구문과형태론적측면에서어려움을보이는것에주목하여단순언어장애아동의문법체계및문법형태소의이해및산출에서의결함을규명하려하는 (Ingram & Morehead, 2002; Leonard, 1989; Rice & Oetting, 1993) 접근이주를이루었다. 그러나의미, 음운, 구문, 형태, 화용등다양한언어영역에서나타나는단순언어장애아동의언어적결함은광범위한개인차를보이며 (Kim, 2004; Stark & Tallal, 1981), 또한단순언어장애아동이언어적과제뿐만아니라다양한언어적, 인지적처리과제에서저조한수행력을보임에따라 (Bishop, 1992; Weismer, 1996), 단순언어장애아동들에게서다양하게표출되는언어적결함을야기하는기저의문제에대한관심으로연구의영역이확장되었다. 최근에는언어발달의기저로서작업기억에주목하는연구들이많아지고있으며 (Gathercole, 1994; Just & Carpenter, 1992; Leonard et al., 2007; Weismer, 1996), 언어장애아동의언어능력의결함을작업기억으로설명하는연구가꾸준히있어왔다 (Bishop, 1992; Gathercole & Baddeley, 1990a; Just & Carpenter, 1992; Kail, 1994; Leonard, 1998; Montgomery, 1995; Swanson, & Sachse-Lee, 2001; Weismer, 1996). 선행연구에의하면작업기억은어휘습득 (Gathercole, Willis, Emslie, & Baddeley, 1992), 문법형태소습득 (Weismer, 1996), 그리고문장이해 (Montgomery, 2000) 등과유의한정적상관관계가있는것으로나타났다. 또한단순언어장애아동 (Montgomery, 1995; Weismer, Evans, & Hesketh, 1999), 자폐아동 (Gathercole, Alloway, Willis, & Adams, 2006; Williams, Goldstein, & Minshew, 2006) 등언어발달장애아동들이일반적으로일반아동에비해작업기억수행력이낮게나타나며, 많은선행연구들에서이러한낮은작업기억수행력과단순언어장애아동의언어결함과의관련성을찾고자하였다 (Gathercole & Baddeley, 1990a; Montgomery, 1995; Swanson & Sachse-Lee, 2001; Waters & Caplan, 1996)

3 어휘발달지체아동을대상으로한작업기억중재가작업기억및언어능력에미치는영향 김신영외 일반적으로작업기억 (working memory) 은제한된양의정보를일시적으로저장하고유지하며조작하는인지처리과정으로정의할수있으며 (Baddeley, 1986), 이러한작업기억은추론, 문제해결, 언어이해와같은복잡한기능을수행할때중심적인역할을한다 (Just & Carpenter, 1992). Baddeley (1986, 2000) 는작업기억을음운루프 (phonological loop), 시공간스케치패드 (visuospatial sketchpad), 일화적완충기 (episodic buffer), 그리고중앙집행기 (central executive) 의네가지요소로구분하였다. 음운루프는음운적작업기억과, 시공간스케치패드는시공간적작업기억과관련이있으며, 일화적완충기는장기기억의정보와지금기억하고자하는정보를연결하고, 중앙집행기는다른세가지하위체계로부터정보를통합하고관리한다. 한편 Just와 Carpenter (1992) 는작업기억을저장 (storage) 과처리 (process) 가동시에일어나는작업공간으로정의한바있으며, 이모형에서는작업기억용량을이러한이원적기능을동시에수행하기위한가용자원의총량으로정의한다. 언어와작업기억, 그리고단순언어장애아동의언어문제와작업기억간의상관관계가여러선행연구들에서보고되면서, 아동의언어발달을평가하고언어장애를선별하기위한도구로써다양한작업기억과제들이개발되어왔다. 음운적작업기억은새로운어휘를배우는데에중요한역할을하는데 (Gathercole & Baddeley, 1990b; Hoff, Core, & Bridges, 2008), 아동이새로운어휘를학습할때에는어휘집에없는생소한음운목록조합을일시적으로저장하는과정이필요하기때문이다. 이러한음운적작업기억을평가하기위한대표적인도구로는비단어따라말하기를들수있다 (Archibald & Joanisse, 2009; Dollaghan & Campbell, 1998; Gathercole, 2006). 많은선행연구에서단순언어장애아동의비단어따라말하기수행력이일반아동에비해유의하게낮음을밝혔으며 (Gathercole & Baddeley, 1990a; Swanson & Sachse-Lee, 2001), 낮은음운적작업기억수행력은어휘발달 (Gathercole & Baddeley, 1990b) 및문장이해 (Montgomery, 1995) 등에영향을미친다고보고하였다. 한편시공간적작업기억을측정하는과제로는매트릭스 (matrix) 과제가있으며 (Cowan et al., 2003; Logie, Zucco, & Baddeley, 1990; Shah & Miyake, 1996; Swanson, 2003), 단순언어장애아동의시공간적작업기억수행력이일반아동에비해유의하게낮음을밝힌선행연구결과들이있다 (Doehring, 1960; Montgomery, 1993; Poppen, Stark, Eisenson, Forrest, & Wertheim, 1969). 텍스트유형에따른글이해능력에대한국내의선행연구에의하면, 읽기에어려움이있는아동은 묘사글 을읽을때시공간작업기억이글이해에미치는간섭효과를보였음을밝히면서 (Do & Lee, 2006), 시공간작업기억이아동의글이해에미치는영향을설명하였다. 앞서기술한바대로 Just와 Carpenter (1992) 는작업기억용량을저장 (storage) 과처리 (process) 의기능을동시에수행하기위한가용자원의총량으로정의한바있는데, 저장과처리의상호작용에관심을두는대표적인과제로 Gaunling과 Campbell이 1994년에제작한 Competing Language Processing Task (CLPT) 를들수있다. 이러한이중처리과제를사용한다수의선행연구들 (Daneman & Carpenter, 1980; Gaulin & Campbell, 1994; Montgomery, 1995, 2000) 에서단순언어장애아동집단은일반아동집단에비해저조한수행력을보였다. 특히 Weismer 등 (1999) 은단순언어장애아동을대상으로한연구에서처리능력과관계된정오판단수행력은또래아동과유사하였으나, 저장능력과관계된단어의회상능력은저조한것으로나타난연구결과를근거로단순언어장애아동의기능적작업기억용량이일반아동에비해제한적임을주장했다. 이렇듯언어능력의주요한기저메커니즘으로주목받고있는작업기억을평가하고단순언어장애를비롯한청각장애, 자폐범주성장애등다양한장애군의작업기억과언어와의상관관계를밝힌선행연구들은꾸준히있어왔으나, 그에비해작업기억용량을확대시키거나작업기억을활성화시키는치료법에대한연구는미비한실정이다. 작업기억용량은개인차가있고일반적으로고정되어있다고알려져왔으나, 뇌의가소성에근거하여작업기억용량을확대시키는중재효과연구가최근대두되고있다. 노년층 (Richmond, Morrison, Chein, & Olson, 2011), 성인층 (Kundu, Sutterer, Emrich, & Postle, 2013), 청소년 (Gibson et al., 2011), 일반아동 (Loosli, Buschkuehl, Perrig, & Jaeggi, 2012) 등다양한세대를대상으로작업기억훈련의효과를입증한연구들이있으며, 국내에서도 ADHD (Kwon, 2013; Park, Park, Cho, & Shin, 2010; Song, Kwon, & Lee, 2013), 학습장애 (Choi, 2011; Kang & Song, 2011), 지적장애 (Ham, 2009; Kim, 2013) 아동을대상으로작업기억훈련이아동의작업기억용량확대에유의한효과를가져왔음을밝혔다. 그러나단순언어장애아동의전형적인지표로알려져있는어휘발달이지체된아동을대상으로한작업기억중재연구는찾아보기힘들고, 작업기억훈련이중재대상자의작업기억용량뿐만아니라언어의다양한영역에미치는영향에대한연구도미비하다. 여러선행연구들에서지적한바대로언어장애아동의낮은언어능력의기저에작업기억이라는근본적처리기제의결함이있다면, 지능이나신체적, 신경적손상없이또래에비해낮은어휘수준을보이는어휘발달지체아동의작업기억을증진시키는중재프로그램을실시한후어휘발달지체아동의작업기억및언어능력이유의하게향상되었는지검토하는연구가필요한때이다. 따라서본연구에서는어휘발달지체아동을대상으로작업기억중재를실시한후 471

4 Shinyoung Kim, et al. Working Memory Intervention for Children with Delay in Vocabulary Development 어휘발달지체아동에게표면적으로나타난언어문제를비롯하여기저의처리기제의결함으로인한과제의저조한수행력이향상될것인가를검토해보고자하였다. 이를위한구체적인연구문제는다음과같다. 첫째, 어휘발달지체아동과일반아동의작업기억과제수행력차이가유의한가? 둘째, 작업기억중재에따른어휘발달지체아동의중재전후작업기억과제수행력차이가유의한가? 셋째, 작업기억중재에따른어휘발달지체아동의중재전후언어능력의차이가유의한가? 연구방법연구대상본연구는서울에거주하는생활연령 5-7세의어휘발달지체아동 6명 (5;7-7;4, 여 3, 남 3), 그리고이들과생활연령을일치시킨일반아동 6명 (5;7-7;1, 여 3, 남 3) 을대상으로하였다. 연구대상의선정기준은다음과같다. 어휘발달지체아동은 (1) 수용 표현어휘력검사 (Receptive & Expressive Vocabulary Test, REVT; Kim, Hong, Kim, Jang, & Lee, 2009) 결과표현어휘력또는수용어휘력이 SD 미만인아동으로서 (2) 카우프만아동용지능검사 (Korean Kaufman Assessment Battery for Children, K- ABC; Moon & Byun, 2003) 의비언어성지능지수가 85점 (-1 SD) 이상이며, (3) 부모또는교사에의해시각, 청각, 신체및기타정서문제가없다고보고된아동으로선정하였다. 또한일반아동은 (1) 수용 표현어휘력검사 (REVT; Kim et al., 2010) 결과표현어휘력과수용어휘력이정상범주 (-1 SD 이상 ) 인아동으로서 (2) 카우프만아동용지능검사 (K-ABC; Moon & Byun, 2003) 의비언어성지능지수가 85점 (-1 SD) 이상이며, (3) 부모또는교사에의해시각, 청각, 신체및기타정서문제가없다고보고된아동으로선정하였다. 본연구에참여한대상자의생활연령과수용및표현어휘력점수, 비언어성지능지수의평균및표준편차를 Table 1에제시하였다. 집단의통제가잘이루어졌는지확인하기위하여만-휘트니 U 검정을실시하였으며, 그결과두집단의생활연령 (Z=.320, p>.05) 과비언어성지능 (Z=1.774, p>.05) 에통계적으로유의한차이가없었고, 수용어휘력 (Z= 2.882, p <.01) 과표현어휘력 (Z= 2.727, p<.01) 에서만유의한차이를보였다. 본연구의중재프로그램에참여한아동정보는 Table 2에제시하였다. 연구절차본연구는작업기억중재가어휘발달지체아동의작업기억용량및언어능력에미치는영향을알아보고자사전-사후검사설계를사용하였다. 사전평가, 작업기억중재, 사후평가로진행되었으며, 연구의구체적인절차는다음과같다. 사전평가사전평가는중재가시작되기전대상아동들의작업기억및언어능력을평가하기위하여실시하였다. 검사는조용한방에서검사자와대상아동이책상에나란히앉아개별적으로이루어졌으며, 검사시간은약 90분소요되었다. 사전평가과제중따라말하기과제는스마트폰 (SHV-E160K) 으로녹음되었으며, 사전평가에사용된과제는다음과같다. 작업기억평가대상아동들의작업기억을평가하기위하여비단어따라말하기과제, 문장폭기억과제, 매트릭스과제를실시하였다. 본연구에서사용된비단어따라말하기 (nonword repetition) 과제는선행연구 (Lee, Kim, & Yim, 2013; Oh & Yim, 2013; Yang, Yim, Kim, & Han, 2013) 에서사용된과제로서, 2-6음절의비단어 20개로구성되어있다. 사전에녹음된비단어들이컴퓨터를통하여제 Table 1. Participants characteristics Characteristic VD group (N= 6) TD group (N= 6) Z Age (mo) (6.63) (7.57).320 REVT-R (8.89) (12.23) 2.882* REVT-E (6.09) (9.77) 2.727* K-ABC (16.62) (5.35) Values are presented as mean (SD). VD = children with delay in vocabulary development; TD = typically developing children; REVT = Receptive & Expressive Vocabulary Test (Kim, Hong, Kim, Jang, & Lee, 2009); K-ABC = Korean-Kaufman Assessment Battery for Children (Moon & Byun, 2003). *p <.01. Table 2. Intervention group characteristics ID (gender) Age (mo) Education level REVT-R REVT-E K-ABC A (F) 88 1st grader B (F) 77 Preschooler C (F) 76 Preschooler D (M) 75 Preschooler E (M) 71 Preschooler F (M) 69 Preschooler F = female; M = male; REVT =Receptive & Expressive Vocabulary Test (Kim, Hong, Kim, Jang, & Lee, 2009); K-ABC = Korean-Kaufman Assessment Battery for Children (Moon & Byun, 2003)

5 어휘발달지체아동을대상으로한작업기억중재가작업기억및언어능력에미치는영향 김신영외 시되었으며, 검사자는아동들에게들려주는비단어를앵무새처럼똑같이따라말하도록지시하였다. 문장폭기억과제 (CLPT) 는선행연구 (Gaulin & Campbell, 1994) 를수정, 보완하여만든과제로서 (Kim & Yim, 2012), 검사자는아동에게녹음된음성파일을컴퓨터로들려주고아동에게예 / 아니요대답과함께마지막단어를회상산출하게한다. 문장을듣고정오를판단하는문장처리와각문장의마지막단어를기억하여회상하는두가지과정이동시에진행되는과제이며, 총 42문항에대해정오판단과단어회상의두가지하위과제각각점수가산출되었다. 매트릭스 (matrix) 과제는선행연구 (Gathercole, Pickering, Ambridge, & Wearing, 2000; Kim & Yim, 2012) 에서사용한과제를수정, 보완하였으며, 컴퓨터화면에제시된 3 3 매트릭스안에서점등하는시각자극을기억하여순서를거꾸로회상하는과제이다. 검정바탕의컴퓨터화면중앙에 3 3 매트릭스의흰색사각형 9개가제시되며, 0.5초의간격으로매트릭스의한칸이주황색으로점등된다. 점등되는칸의수는 2개 ( 난이도 1) 부터 5개 ( 난이도 4) 로점차늘어나며, 아동은각문항에서정지화면이나타난후빈매트릭스가제시되면, 점등된매트릭스의칸을거꾸로회상하여손가락으로짚는다. 모든과제는연습문항에서아동이과제를완전히숙지했다고판단될때까지반복적으로훈련한후본문항을실시하였으며, 과제의정확도는정반응률로측정하였다. 본연구에서사용된작업기억과제들의타당도를검증하기위하여 Kendall W 검증을실시하였으며, 그결과작업기억을측정하기위한과제들간상관관계가유의한것으로나타났다 (Kendall W=.710, p<.0001). 언어능력평가대상아동들의언어능력을의미론적, 형태론적, 구문론적영역에서다각적으로평가하기위하여, 선별과제로사용한 REVT 외에한국아동토큰검사, 문장따라말하기과제, 문법성판단과제를실시하였다. 한국아동토큰검사 (Korean-Token Test for Children-2, K-TT- FC-2; Shin, Kim, Chung, & Kim, 2011) 는 3-12세아동의청각적언어이해력을평가하는표준화검사로서, 아동은검사자의구어지시문을듣고크기, 모양, 색상의세가지측면에서서로다른 20개의토큰을조작한다. 본검사로써아동의듣기이해력및주의산만과충동성등주의집중과관련된기타문제등을평가할수있다. 문장따라말하기 (sentence repetition) 과제는선행연구 (An & Kim, 2000; Park, Yoon, Han, & Yim, 2014) 에서사용된과제를수정하여문항을구성하였으며, 각아동들에게컴퓨터를통하여음 성파일로제시되었다. 과제의문항은 3낱말단문 9문항, 5낱말단문 9문항, 5낱말접속문 9문항, 5낱말내포문 8문항의총 35문항으로구성되었으며, 아동에게들려주는문장을정확히따라말하도록지시하였다. 각문항당모든어절에서정반응하였을때 1점을, 하나의어절에서라도오반응을보인경우 0점을부과하였으며, 과제의정확도는정반응률로측정하였다. 문법성판단과제는선행연구 (An, 2013; Lee, 1996) 에서사용된과제를수정하여문항을구성하였으며, E-Prime을사용하여프로그래밍한과제를컴퓨터로제시하여반응속도를측정하였다. 과제의문항은연습문항 5개를제외하고비문과정문이각각 15개씩 30 문항으로구성되었으며, 컴퓨터에흑백의그림이나타나고 500 ms 후그림을설명하는음성이제시되면아동이정오를판단하여키보드의특정버튼을누르도록하였다. 연습문항에서아동이과제를완전히숙지했다고판단될때까지반복적으로훈련한후본문항을실시하였으며, 아동에게정오판단과동시에최대한빠르게버튼을누르도록지시하였다. 과제의정확도는정반응률로측정하였으며, 반응속도는 ms로측정하였다. 작업기억과제들과마찬가지로본연구에서사용된언어능력측정과제들의타당도검증을위해 Kendall W 검증을실시하였으며, 그결과과제들간상관관계가유의한것으로나타났다 (Kendall W=.860, p<.0001) 중재본연구에서참고한구어적작업기억중재프로그램을사용한선행연구 (Choi, 2011; Ham, 2009) 에의하면, 주 3회의총 20-21회기의중재가지적장애아동및학습장애아동의언어과제수행력향상에유의한효과를가져왔다. 집중적인작업기억중재의효과는많은선행연구들에서보고된바 (Holmes et al., 2010; Kronenberger, Pisoni, Henning, Colson, & Hazzard, 2011), 본연구에서도작업기억중재를각아동별로주 3회씩 5주에걸쳐총 15회기실시하였다. 사후평가사후평가는최종중재가종료된직후또는 3-4일 (Beck, Hanson, Puffenberger, Benninger, & Benninger, 2010; Loosli et al., 2012) 후실시한선행연구들을참고하여, 적어도중재가종료된후 1주일내에사전평가와동일한과제로실시하였다. 작업기억중재프로그램작업기억중재자료의구성본연구에서사용된작업기억중재프로그램은 Kwon (2003) 과 473

6 Shinyoung Kim, et al. Working Memory Intervention for Children with Delay in Vocabulary Development Conners (2003) 의연구를토대로한선행연구 (Choi, 2011; Ham, 2009) 에서지적장애아동및학습장애아동을대상으로언어이해력및언어과제수행력에유의한향상을가져온프로그램을수정보완한것으로서, 본연구의대상아동의연령과특징을고려하여재구성하였다. 중재에사용된어휘는그림자료로나타내기위하여명사로한정하였다. Chang, Jeon, Shin과 Kim (2013, 2014) 의연구에서학령전기및학령기아동의기초어휘로선정된명사중사전-사후평가과제인수용 표현어휘력검사 (Kim et al., 2010) 문항을제외하여사후평가과제에명시적인학습이되지않도록방지하였다. 의미범주는해당연구의분류를참고하였으며, 중재에사용된어휘의목록은 Appendix 1에제시하였다. 시각적범주화에사용된그림자료는 Microsoft Power Point 2000 을사용하여제시되었으며, 각단계별로제시되는모든그림은한슬라이드에배치되어아동이화면을보고손가락으로짚으며범주화하도록하였다. 그림은컬러로제시되었으며, 매회기는그림자극 3개 (1단계) 에서부터 7개 (5단계) 까지 5개슬라이드로구성되었다. 그림자료의예시는 Appendix 2에제시하였다. 작업기억중재프로그램의구성중재는연구자와아동이독립된공간에서책상에나란히또는마주앉아진행되었으며, 각회기는아동의수행력에따라약 30분에서 40분의시간이소요되었다. 중재프로그램은매회기자유회상, 시연, 청각적언어기억, 범주화의네가지과제로구성되었으며, 아동의수행력은각과제최종성공단계 ( 단어개수 ) 로기록하였다. 회기의구성은 Table 3에제시하였다. 모든과제에서각단계는두번연속정반응시다음단계로이행하였고, 세번연속오반응시활동을마쳤다. 또한네번중두번정반응시그단계를성공한것으로간주하였다. 아동이오반응한경우에는사전에설정된구체 적인중재프로토콜을따르도록하였다. 구체적인회기의내용은 Appendix 3에제시하였다. 자유회상이과제에서는연구자가아동에게주제단어를제시하면, 아동이주제단어와관련된단어를회상하여말하도록하였다. 예를들어, 연구자가 동물이름한번말해보자. 라고하면, 아동은 사자, 호랑이, 원숭이 등자유롭게동물이름을회상하여산출하였다. 1분내에주제단어와관련된단어를 10개이상산출하는것이목표이며, 제한시간내에목표단어 10개를달성하지못한경우연구자는아동에게 동물원에가면뭐가있지? 등의의미적단서를제공하였다. 제한시간이지나기전에아동이연구자에게단서제공을요구하는경우응하지않고아동에게스스로회상하기를격려하였다. 아동이회상한단어가운데회기의목표단어가없는경우연구자는해당목표단어를아동이알고있는지확인하여, 아동의어휘집에없는단어일경우그회기의중재에사용되는단어에서제외하였다. 이는본연구에사용된작업기억중재프로그램이작업기억만을훈련하는것으로어휘학습부담이더해지는것을막기위함이며, 해당어휘는중재기록지에별도로기록하여이후의회기에서반복적으로상기시켜학습할수있도록하였다. 시연이과제에서는연구자가아동에게구어로목표단어를하나씩제시하면아동은이를듣고점증적으로목록을늘려순서대로시연 (repeat) 하도록하였다. 아동에게 기찻길놀이를해보자. 라고제안하며, 연구자가 사자 라고하면아동은 사자 라고시연하고, 이어서연구자가 호랑이 라고하면아동은앞서의단어에덧붙여 사자, 호랑이 라고시연하게하였다. 제시되는단어의개수는 1개부터최대 7개까지로하였으며, 각회기의목표어휘들은사전에무 Table 3. Structure of session Procedure (time) Goal Reinforcement 1. Opening (5 min) Rapport forming 2. Free recall (5 min) Recall more than 10 target vocabulary words related to the topic vocabulary word (1 min time limit) Color the squares of graph paper corresponding with the number of vocabulary words recalled 3. Rehearsal (5 min) Present 1-7 vocabulary words Stamp on graph paper corresponding with the number of vocabulary words demonstrated 4. Auditory language recall (10 min) - Recall by sequence - Recall in random order 5. Categorization (10 min) - Visual organization - Auditory organization Present 2-7 vocabulary words Present 3-7 vocabulary words 6. Closing (5 min) Wrap up and social reinforcement Stamp on graph paper corresponding with the number of vocabulary words recalled by sequence Sticker on graph paper corresponding with the number of vocabulary words successfully organized aurally 474

7 어휘발달지체아동을대상으로한작업기억중재가작업기억및언어능력에미치는영향 김신영외 작위배정되어 52개의목록으로만들어져단계별로연구자가선택하여사용할수있도록하였다. 청각적언어기억이과제에서는연구자가아동에게단어의목록을구어로제시하고아동이이를기억하여말하도록하였다. 이과제는연구자가들려주는단어의목록을아동이순서대로기억하여말하는과제와순서에상관없이기억하여말하는두개의하위과제로나뉜다. 선생님이말하는단어를모두기억해서순서대로말해보자. 라고지시한후, 아동이연구자가제시한순서와일치하게답하는경우에만정반응으로간주하였다. 프로토콜에따라과제의한계선 (ceiling) 에이른경우, 이번에는순서에상관없이선생님이말하는단어를한꺼번에다말해보자. 라고지시하고, 아동이순서에맞지않게답하여도단어의목록이일치하면정반응으로간주하고다음단계로이행하였다. 연구자가제시하는단어는 2개부터최대 7개까지로하였으며, 목표어휘목록은단어의개수별로사전에제작되어 52개의목록중연구자가선택하여사용할수있도록하였다. 범주화이과제는자극의종류에따라두개의하위과제로나뉘며, 연구자는두가지의미범주로분류할수있는단어의목록을아동에게제시하고아동에게범주별로분류하여답하도록하였다. 제시되는단어는 3개부터최대 7개까지로하였으며, 시각적자극제시과제를마친후청각적자극제시과제로이행하였다. 시각적자극제시과제는두가지범주로분류할수있는그림자료를 Microsoft Power Point 2010 을사용하여한슬라이드에동시에보여주고, 아동이화면을보고각그림의이름대기에정반응한경우 친구끼리묶어보자. 라고말하며범주화하게하였다. 아동이그림의이름대기에서오반응을보이는경우그림체가친숙하지않아서인지아니면단어를모르는것인지확인후그림체의오인으로인한것인경우에는정반응으로간주하였다. 아동이범주화에어려움을보이면 이중에서동물을찾아보자., 나머지는뭘까? 라고말하며분류기준단서를제공하였다. 범주화에정반응한경우아동에게 사자와토끼는왜친구야? 라고질문하여분류기준에대해답하게하였다. 여기에오반응시 사자와토끼는동물이어서친구야. 라고답을알려주었다. 청각적자극제시과제는두가지범주로분류할수있는단어목록을연구자가아동에게구어로들려주고, 아동이회상산출한후범주별로분류하게하였다. 첫번째시도는시각적자극제시와동일한단어목록을사용하였으며, 회상에오반응시같은단계의다 른목록을다시아동에게들려주었다. 회상은순서에상관없이목표어휘를모두회상하면정반응으로간주하였으며, 회상에정반응시범주별분류하기와분류기준제시하기로이행하였다. 아동은회상한단어를두가지범주로분류하고, 사자와토끼는동물이어서친구에요., 김밥과떡은음식이어서친구에요. 라고분류기준제시까지정반응했을때그단계를최종적으로성공한것으로간주하였다. 자료분석및자료의통계적처리표준화된검사도구인수용 표현어휘력검사 (REVT), 카우프만아동용지능검사 (K-ABC), 그리고한국아동토큰검사 (K-TTFC-2) 의분석은해당검사도구의지침서에따라실시하였다. 작업기억과제및언어능력과제는아동의반응을검사가진행되는동안반응기록지에모두기록하였으며, 모든과제는문항별로정반응한경우 1점, 오반응한경우 0점을부과하였다. 문법성판단과제는컴퓨터프로그램 (E-Prime) 을통해반응시간을측정하였으며, 반응이자동적으로기록되게하였다. 반응시간은정반응문항의반응시간만을측정치로하였으며, 각아동평균의 ±2 SD 이상의측정치는가외치 (outlier) 로간주하여제외한후 (Kail, 1994; Spaulding, 2010) 다시반응시간의평균을산출하였다. 비단어따라말하기과제는단어수준점수산출방법을사용하였으며 (Hwang, 2014), 문장따라말하기과제는문장수준점수산출방법을사용하였다. CLPT는 42 개의문항별로정오판단과단어회상의두가지하위과제에대하여각각점수가산출되었다. 어휘발달지체아동과일반아동의작업기억수행력차이를살펴보기위해비모수통계기법중만-휘트니 U 검정 (Mann-Whitney U- test) 을실시하였으며, 작업기억중재에따른어휘발달지체아동의작업기억및언어능력의차이를검정하기위하여비모수통계기법중윌콕슨부호- 서열검정 (Wilcoxon signed-ranks test) 을실시하였다. 본연구의모든통계적분석은 SPSS Statistics 19.0 을사용하였다. 연구결과어휘발달지체아동과일반아동의작업기억수행력차이작업기억중재실시전어휘발달지체아동과일반아동의작업기억과제수행력에차이가있는지확인하기위하여만-휘트니 U 검정 (Mann-Whitney U-test) 을실시하였다. 두집단의작업기억과제정반응률에대한기술통계와만-휘트니 U 검정결과는 Table 4, Figure 1과같다. 기술통계결과모든과제에서일반아동집단의정반응률이높 475

8 Shinyoung Kim, et al. Working Memory Intervention for Children with Delay in Vocabulary Development Table 4. Descriptive statistics and Mann-Whitney U-test results (%) of working memory tasks by groups Task VD (N = 6) TD (N = 6) Z CLPT accuracy (9.84) (2.88) 2.012* CLPT recall (11.64) (8.70) 2.406* NWR (8.16) (13.20) 2.513* Matrix (5.83) (13.61) 2.115* Values are presented as mean (SD). VD = children with delay in vocabulary development; TD = typically developing children; CLPT = Competing Language Processing Task; NWR = nonword repetition. *p <.05. Table 5. Descriptive statistics and Wilcoxon signed-rank test results (%) of working memory tasks at pre/post-intervention in VD group (N= 6) Pre-intervention Post-intervention Z CLPT accuracy (9.84) (7.48).943 CLPT recall (11.64) (11.13) 2.207* NWR (8.16) (16.25).405 Matrix (5.83) (23.57) Values are presented as mean (SD). VD = children with delay in vocabulary development; CLPT = Competing Language Processing Task; NWR = nonword repetition. *p < VD TD Pre Post (%) 40 (%) CLPT accuracy CLPT recall NWR Matrix 0 CLPT accuracy CLPT recall NWR Matrix Figure 1. The performance of working memory tasks (%) between VD and TD. VD = children with delay in vocabulary development; TD = typically developing children; CLPT= Competing Language Processing Task; NWR= nonword repetition. 은것으로나타났다. 통계적유의성을검토하기위하여만 - 휘트니 U 검정 (Mann-Whitney U-Test) 을실시한결과, CLPT- 정오판단 (Z= 2.012, p<.05), CLPT- 단어회상 (Z= 2.406, p<.05), 비단어따 라말하기 (Z= 2.513, p<.05), 매트릭스 (Z= 2.115, p<.05) 과제모두 집단간수행력차이가통계적으로유의한것으로나타났다. 즉, 어 휘발달지체아동집단의작업기억과제수행력이일반아동집단에 비해유의하게낮았다. 작업기억중재가작업기억용량에미치는영향 어휘발달지체아동을대상으로한작업기억중재가중재대상 아동의작업기억용량에미치는영향을알아보기위하여윌콕슨 부호 - 서열검정 (Wilcoxon signed-rank test) 을실시하였다. 사전 - 사 후작업기억과제의정반응률기술통계량및윌콕슨부호 - 서열검 정결과는 Table 5, Figure 2 와같다. 기술통계결과 CLPT ( 정오판단, 단어회상 ) 와매트릭스과제의 작업기억중재후정반응률이높아졌으나, 통계적으로유의한차이 를보인것은 CLPT- 단어회상 (Z= 2.207, p<.05) 과제인것으로나타 났다. 즉, 작업기억중재에따라어휘발달지체아동집단의 CLPT- 단어회상과제의수행력이유의하게높아졌다. Figure 2. The performance of working memory tasks (%) at pre/post-intervention in children with delay in vocabulary development. 작업기억중재가언어능력에미치는영향 어휘발달지체아동을대상으로한작업기억중재가중재대상 아동의언어능력에미치는영향을알아보기위하여윌콕슨부호 - 서열검정 (Wilcoxon signed-rank test) 을실시하였다. 사전 - 사후언 어능력과제의기술통계량및윌콕슨부호 - 서열검정결과는 Table 6, Figures 3-5 와같다. 기술통계결과모든과제의수행력이높아졌으며, 문법성판단 - 정확도를제외한모든과제에서통계적으로유의한차이를보였다. 즉, 작업기억중재후 K-TTFC (Z= 2.032, p<.05), REVT-R (Z= 2.207, p<.05), REVT-E (Z=1.992, p<.05), 문장따라말하기 (Z=1.992, p <.05), 문법성판단 - 반응속도 (Z= 2.201, p <.05) 의수행력이유의 하게향상되었다. 논의및결론 본연구는어휘발달지체아동과일반아동의작업기억용량을 CLPT, 비단어따라말하기, 매트릭스과제수행력으로비교해보고, 어휘발달지체아동집단을대상으로작업기억중재실시후중재 대상집단의작업기억용량및언어능력에미치는영향을알아보 고자하였다

9 어휘발달지체아동을대상으로한작업기억중재가작업기억및언어능력에미치는영향 김신영외 Table 6. Descriptive statistics Wilcoxon signed-rank test results of language tasks at pre/post-intervention in VD group (N= 6) Pre-intervention Post-intervention Z SR (%) (20.64) (16.92) 1.992* GJT accuracy (%) (9.76) (8.80) GJT reaction time (ms) 4, (814.14) 4, (961.01) 2.201* K-TTFC (10.84) (7.12) 2.032* REVT-R (8.89) (14.32) 2.207* REVT-E (6.09) (4.97) 1.992* Values are presented as mean (SD). VD = children with delay in vocabulary development; SR= sentence repetition; GJT= grammaticality judgment task; K-TTFC = Korean-Token Test for Children (Shin, Kim, Chung, & Kim, 2011); REVT = Receptive & Expressive Vocabulary Test (Kim, Hong, Kim, Jang, & Lee, 2009). *p <.05. (%) SR GJT accuracy Pre Post Figure 3. SR and GJT performance (%) at pre/post-intervention in children with delay in vocabulary development. SR= sentence repetition; GJT= grammaticality judgment task. Score Reaction time (ms) ,000 5,000 4,000 3,000 2,000 1,000 0 GJT Figure 4. GJT performance at pre/post-intervention in children with delay in vocabulary development. GJT= grammaticality judgment task. K-TTFC REVT-R REVT-E Pre Post Pre Post Figure 5. K-TTCF and REVT performance (%) at pre/post-intervention in children with delay in vocabulary development. SR = sentence repetition; GJT = grammaticality judgment task; K-TTFC = Korean-Token Test for Children (Shin, Kim, Chung, & Kim, 2011); REVT = Receptive & Expressive Vocabulary Test (Kim, Hong, Kim, Jang, & Lee, 2009). 본연구에서어휘발달지체아동집단과일반아동집단간작업기억용량에차이가있는지알아보기위하여세가지작업기억과제의집단간수행력차이를비교한결과, CLPT와비단어따라말하기, 매트릭스모두에서집단간유의한차이가나타났다. 즉, 어휘발달지체아동집단이 CLPT 정오판단및단어회상모두에서정확도가유의하게낮아어휘발달지체아동은정보의저장및처리에필요한용량이일반아동에비해낮은것으로나타났다. 또한음운기억용량을측정하는비단어따라말하기의수행력도유의하게낮아, 음운작업기억이일반아동에비해손상되었을뿐아니라 (Estes, Evans, & Else-Quest, 2007; Swanson & Sachse-Lee, 2001), 비단어따라말하기과제가일반아동과언어장애아동을구별할수있는유용한도구가될수있다는선행연구 (Dollaghan & Campbell, 1998; Weismer & Evans, 2002) 결과를뒷받침하였다. 또한본연구결과시공간작업기억을측정하기위한매트릭스과제에서도어휘 발달지체아동의수행력이일반아동에비해유의하게낮게나타났다. 이는단순언어장애아동을대상으로시공간작업기억을평가한선행연구결과 (Archibald & Gathercole, 2006; Hong & Yim, 2014) 및단순언어장애아동의시공간적작업기억이일반아동에비해한계가있음을밝힌선행연구 (Montgomery, 1993; Poppen et al., 1969) 와같다. 본연구결과어휘발달지체아동집단은일반아동집단에비해정보의저장및처리의총량으로판단한작업기억용량및작업기억의두가지하위요소인음운기억과시공간작업기억의용량이낮음을확인하였다. 이에본연구에서는어휘발달지체아동을대상으로구어작업기억을촉진하는중재프로그램을적용하여중재전후작업기억용량및언어능력에미치는영향을알아보고자하였다. 어휘발달지체아동을대상으로구어작업기억을촉진하는중재를제공한후작업기억용량에차이가있는지알아보고자중재전 477

10 Shinyoung Kim, et al. Working Memory Intervention for Children with Delay in Vocabulary Development 후세가지작업기억과제의수행력을비교한결과, 유의한차이가나타난과제는 CLPT-단어회상인것으로나타났다. CLPT는기능적작업기억을측정하는대표적인과제로서, 정보를저장하고처리하는연합적기능을동시에측정한다. 기능적작업기억모형에따르면 CLPT 과제의정오판단과단어회상각각또는이두개모두의수행력은두과제들이이용할수있는자원인작업기억용량을모두쓰면감소하게된다. 이때단어회상의수행력은기억용량의평가뿐만아니라처리자원이할당되는효율성을나타낸다 (Weismer, Evans, & Hesketh, 1999). 본연구결과에의하면작업기억중재후어휘발달지체아동집단의 CLPT 과제수행력은기술통계결과정오판단과단어회상모두에서높아졌지만, 통계적으로유의한향상을보인것은단어회상이다. CLPT의두개하위과제인저장 ( 단어회상 ) 과처리 ( 정오판단 ) 를포괄한전체과제수행력을어휘발달지체아동의기능적작업기억용량으로본다면, 작업기억중재를통하여기능적작업기억용량이증가하였다고할수있다. 또한하위과제중정오판단과제가아닌단어회상과제의수행력향상이유의했다는것은, Weismer 등 (1999) 의설명에따르면중재대상아동의처리자원이효율적으로할당되었다고할수있다. 즉, 본연구를통한작업기억중재로어휘발달지체아동의가용할수있는기능적작업기억용량이확대되었으며, 동시에제한된작업기억공간에서자원을공유하는저장과처리의양기능간효율적인자원배분이일어나게되었음을의미한다. 한편 Baddeley (1986) 의음운작업기억모형의대표적인두가지하위체계인음운루프와시공간스케치패드의수행력을측정하는비단어따라말하기와매트릭스과제에서는작업기억중재전후유의한차이가나타나지않았다. 이에대해본연구에서사용된구어작업기억중재프로그램은비단어따라말하기과제가측정하는음운수준작업기억과달리, 중재에사용된어휘가모두실제단어 (real word) 인것에주목해볼수있다. 시연과회상활동으로훈련된작업기억영역이어휘수준에서음운수준으로전이되지못한것으로해석해볼수있으며, 이는매트릭스과제의중재전후차이가유의하지않은점에서구어작업기억중재의효과가시공간적작업기억영역에전이되지않은것에서도비슷하게확인할수있다. 한편작업기억모형에서중앙집행기는음운루프와시공간스케치패드, 일화적완충기로부터정보를통합하고총괄하는상위체계로기능하는데, 비단어따라말하기과제와매트릭스과제가측정하지못하고있는상위영역인중앙집행기에주목할필요가있을것이다. 본연구에서는작업기억중재가어휘발달지체아동집단의언어능력에미치는영향을어휘, 청각적언어이해력, 문법및구문능력의측면에서검토해보고자하였다. 유의한차이가나타난것은어휘 (REVT), 문장따라말하기, 문법성판단 -반응속도, 청각적언어이해력 (K-TTFC) 이며, 문법성판단의정확도에서는중재전후유의한차이가나타나지않았다. 우선어휘와관련하여, REVT는어휘이해및표현능력을평가하는과제로서, 수용어휘력검사는보기그림중평가자가들려주는낱말을아동이고르도록하며, 표현어휘력검사는이름대기 (naming) 방법으로아동의어휘력을평가한다. 이름대기는낱말찾기 (word finding) 능력과관계가있는데 (Kim et al., 2010), 본연구결과에의하면어휘발달지체아동은중재전에비해중재후낱말찾기의수행력이더높아졌다고할수있다. 언어장애아동들이낱말찾기에어려움을보이는것에대하여선행연구 (Kail et al., 1984) 에서는저장가설 (storage hypothesis) 과인출가설 (retrieval hypothesis) 로설명을했는데, 여기에서는인출가설에주목하고자한다. 낱말찾기장애에대해저장가설은제한된어휘저장능력으로설명하며 (Leonard et al., 1983; McGregor, 1997; McGregor & Windsor, 1996), 인출가설은이미기억속에저장되어있는어휘를효율적이며정확하게인출하지못했을때낱말찾기장애가나타난다고설명한다 (Lee & Kim, 2002; McGregor, 1994; McGregor & Leonard, 1989). 본연구에서사용된작업기억중재는목표낱말선정시 REVT에수록된낱말을제외하였으며, 중재기간도 5주로서아동의어휘집확장에큰영향을미치지않았을것으로판단된다. 그럼에도불구하고 REVT로평가한어휘력이유의하게향상된것은, 작업기억중재를통해대상아동들이이미아동의어휘집에저장되어있었던어휘들을효율적이며정확하게인출할수있었음을의미한다고볼수있다. 문장따라말하기와문법성판단은아동의구문적능력을평가할수있는과제로서, 문법성판단의정확도는기술통계결과높아진것으로나타났지만통계적으로유의하지않았고, 문장따라말하기의정반응률과문법성판단의반응속도는유의하게향상하였다. 문장따라말하기는제시되는문장을그대로회상하기위해청각적으로입력되는정보를통합하고, 그문장을의미론및구문론적으로분석하며, 산출을계획하여실행하는서로다른인지처리과정이동시에필요 (Alloway, Gathercole, Willis, & Adams, 2004) 한과제이며, 문법성판단은형태론적능력만을평가하는것으로서, 문장따라말하기과제는아동의형태론, 구문론적능력을보다다각적으로평가한다. 문법성판단과제의정반응률은중재전후유의한차이가나타나지않았으나반응속도가유의하게빨라진것은, 과제를수행하는데필요한아동의처리능력중속도 (rate) 의향상을의미한다. 즉, 본연구의결과는작업기억중재로 Kail과 Salthouse (1994) 가처리능력을결정하는요소로제시한공간 (space), 에너지 (energy), 속도 (rate) 중시간적측면인속도가향상됨을보임으로 478

11 어휘발달지체아동을대상으로한작업기억중재가작업기억및언어능력에미치는영향 김신영외 써, 중재대상아동이처리과정에가용할수있는에너지를더욱효율적으로쓸수있게되었음을보여준다. Ullman과 Pierpont (2005) 가제안한 Procedural Deficit Hypothesis (PDH) 에따르면, 장기기억은서술기억 (declarative memory) 과절차기억 (procedural memory) 으로나눌수있는데, 언어에있어서어휘의측면은서술기억에, 문법적측면은절차기억에관계된다. 이입장을견지하는선행연구들에서는, 단순언어장애아동이내용어에서는손상을보이지않으나기능어에서또래일반아동들에비해낮은수행력을보이는점을경험적연구 (Tomblin, Mainela- Arnold, & Zhang, 2007) 를예로들어밝히며, 단순언어장애아동이절차기억과관련된뇌의특정영역에문제가있음을주장한다. 본연구에서문법적 / 비문법적문장을판단하는속도와다양한구문적능력을평가하는문장따라말하기과제의수행력에유의한향상을보인것은, 작업기억중재에따라어휘발달지체아동의절차기억과관련된문법영역이긍정적영향을받았음을의미한다. PDH에의하면작업기억또한절차기억과관계된뇌의영역과밀접하게연관되어있으며, 이영역안의다른기능들과도상호관련되어있다고한다 (Ullman & Pierpont, 2005). 즉, 절차기억은작업기억과도관련이있는바, 본연구의구어작업기억중재프로그램이어휘발달지체아동의절차기억에직접적인영향을준것으로볼수있으며, 따라서 PDH를지지한다. 한편, 중재후어휘발달지체아동의 K-TTFC 점수도유의하게높아졌는데, 이러한연구결과는 K-TTFC와작업기억검사간유의한상관관계를밝힌선행연구다. 본검사는아동의청각적언어이해력을평가하고, 동시에주의산만과충동성등주의집중과관련된기타문제를평가하며 (Shin & Lee, 2010), 청각적작업기억을측정하기위해사용되기도한다 (Chung & Shin, 2012). 작업기억의하위요소중중앙집행기는나머지세요소인음운루프, 시공간적스케치패드, 임시적완충기로부터보충을받으며정보의처리과정전체를제어하고통제및판단하는핵심적인체계로작동한다. 주의집중은중앙집행기의기능으로서, 작업기억의중앙집행기와관련하여자기조절능력과간섭자극에대한억제및저항간의상관관계를밝힌선행연구 (Swanson & Howell, 2001) 가있다. K-TTFC 과제는아동의주의집중과도관련이있는과제이므로 (Chung & Shin, 2012; Shin & Lee, 2010), K-TTFC 의수행력향상은작업기억중재에따른중앙집행기기능의활성화로설명할수있다. 본연구에서사용된작업기억중재프로그램은정보의회상과저장, 처리를훈련하는프로그램으로, 구어작업기억과함께아동의주의집중을필요로하였다. 따라서 K-TTFC의수행력향상은본연구에서사용된작업기억중재프로그램의직접적효과라고볼수있으며, 나아가 작업기억의상위영역으로알려져있는집행기능 (executive function) 의주요요소가주의집중 (attention) 인것을고려해볼때, 후속연구로서집행기능으로의전이효과까지검토해볼만한결과라고하겠다. 본연구의대상자는실험집단인어휘발달지체아동 6명, 통제집단인일반아동 6명으로, 중재대상자가된실험집단의크기가작아본연구의결과인작업기억중재의효과를일반화시키는것에제한점이있다. 후속연구에서는대상자수의확대와, 작업기억용량이 4세부터 14세까지꾸준히발달함을밝힌선행연구 (Gathercole et al., 2004) 를토대로대상자연령범위의확대가필요할것으로보인다. 또한작업기억중재의효과를명확히확인하기위해서는실험집단을두개로나누어한집단에만작업기억중재를실시하고다른집단에는작업기억중재를적용하지않는플라시보통제집단설계가필요하다. 그러나본연구에서는플라시보통제집단없이하나의실험집단에대해서작업기억중재전후사전-사후평가를실시하여그차이를비교한것에제한점이있다. 후속연구에서는플라시보통제집단을설정하여연구를진행하여연구의내적타당도를높이되, 연구종료후동일한중재를제공하는등의윤리적인측면을고려하여야할것이다. 또한본연구에서는연구대상아동에게시각, 청각, 기타감각적문제및정서문제가없음을부모또는교사보고에의해서만확인하였는데, 이에대한보다엄밀한검증과정이없었다는것을한계점으로지적할수있을것이다. 그리고본연구의구어작업기억중재프로그램의구성요소가의미단위의 낱말 이어서, 중재프로그램을수행할때대상아동의언어적능력이영향을미쳤을수있다는점또한한계점으로생각할수있다. 동일한프로토콜을사용하되의미적지식의영향을배제한목록으로중재프로그램을구성하여그효과를살펴보는후속연구가필요할것으로보인다. 한편본연구는중재연구의특성상사전- 사후평가시점간중재대상자와연구자간라포형성에따른과제수행력차이를간과할수없다. 후속연구에서는이를통제한연구설계에대하여고민해보아야할것이다. 본연구의결과와관련하여, 작업기억의두가지하위영역인음운루프와시공간스케치패드를평가하는과제의중재전후차이가유의하지않았으나, 중앙집행기기능과관련있는 K-TTFC에유의한향상을보인결과에주목하고자한다. 집행기능 (executive function) 은작업기억과주의집중 (attention), 억제조절 (inhibition), 인지적유연성 (cognitive flexibility) 등을포괄하는상위의인지영역 (Dawson & Guare, 2010) 으로알려져있는바, 집행기능과의관련성을후속연구를통해검토해볼수있을것이다

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15 어휘발달지체아동을대상으로한작업기억중재가작업기억및언어능력에미치는영향 김신영외 McGregor, K. K., & Appel, A. (2002). On the relation between mental representation and naming in a child with specific language impairment. Clinical Linguistics & Phonetics, 16, McGregor, K. K., & Leonard, L. B. (1989). Facilitating word-finding skills of language-impaired children. Journal of Speech and Hearing Disorders, 54, McGregor, K. K., & Windsor, J. (1996). Effects of priming on the naming accuracy of preschoolers with word-finding deficits. Journal of Speech, Language, and Hearing Research, 39, Menyuk, P., & Looney, P. L. (1972). Relationships among components of the grammar in language disorder. Journal of Speech, Language, and Hearing Research, 15, Montgomery, J. W. (1993). Haptic recognition of children with specific language impairment: effects of response modality. Journal of Speech, Language, and Hearing Research, 36, Montgomery, J. W. (1995). Sentence comprehension in children with specific language impairment: the role of phonological working memory. Journal of Speech, Language, and Hearing Research, 38, Montgomery, J. W. (2000). Verbal working memory and sentence comprehension in children with specific language impairment. Journal of Speech, Language, and Hearing Research, 43, Moon, S., & Byeon, C. (2003). Korean-Kaufman Assessment Battery for Children (K-ABC). Seoul: Hakjisa. Morehead, D. M., & Ingram, D. (1973). The development of base syntax in normal and linguistically deviant children. Journal of Speech, Language, and Hearing Research, 16, Oetting, J. B., Rice, M. L., & Swank, L. K. (1995). Quick incidental learning (QUIL) of words by school-age children with and without SLI. Journal of Speech, Language, and Hearing Research, 38, Oh, D. Y., & Yim, D. (2013). Non-word repetition and sentence repetition performance in 2-3 years old late talkers and normal children. Communication Sciences & Disorders, 18, Park, M. Y., Park, S. M., Cho, S. Z., & Shin, M. S. (2010). The effect of CBTbased training using computer games for ADHD children. Korean Journal of Clinical Psychology, 29, Park, W. J., Yoon, S. R., Han, B. Y., & Yim, D. (2014). A comparison of scoring methods on the sentence repetition test in Korean children with delayed language development. Journal of Speech-Language & Hearing Disorders, 23, Paul, R. (1993). Outcomes of early expressive language delay. Journal of Childhood Communication Disorders, 15, Poppen, R., Stark, J., Eisenson, J., Forrest, T., & Wertheim, G. (1969). Visual sequencing performance of aphasic children. Journal of Speech, Language, and Hearing Research, 12, Rescorla, L. (2002). Language and reading outcomes to age 9 in late-talking toddlers. Journal of Speech, Language, and Hearing Research, 45, Rescorla, L., Roberts, J., & Dahlsgaard, K. (1997). Late talkers at 2: outcome at age 3. Journal of Speech, Language, and Hearing Research, 40, Rice, M. L., Cleave, P. L., & Oetting, J. B. (2000). The use of syntactic cues in lexical acquisition by children with SLI. Journal of Speech, Language, and Hearing Research, 43, Rice, M. L., & Oetting, J. B. (1993). Morphological deficits of children with sli: evaluation of number marking and agreement. Journal of Speech, Language, and Hearing Research, 36, Rice, M. L., Wexler, K., & Hershberger, S. (1998). Tense over time: the longitudinal course of tense acquisition in children with specific language impairment. Journal of Speech, Language, and Hearing Research, 41, Rice, M. L., Wexler, K., & Redmond, S. M. (1999). Grammaticality judgments of an extended optional infinitive grammar: evidence from English-speaking children with specific language impairment. Journal of Speech, Language, and Hearing Research, 42, Richmond, L. L., Morrison, A. B., Chein, J. M., & Olson, I. R. (2011). Working memory training and transfer in older adults. Psychology and Aging, 26, Schwartz, A. H., & Daly, D. A. (1976). Some explicit guidelines for constructing and scoring elicited imitation tasks. Language, Speech, and Hearing Services in Schools, 7, Shah, P., & Miyake, A. (1996). The separability of working memory resources for spatial thinking and language processing: an individual differences approach. Journal of Experimental Psychology: General, 125, Shin, M. J., Kim, Y. T., Chung, B. J., & Kim, J. O. (2011). Korean-Token Test for Children-2 (K-TTFC-2). Seoul: Hakjisa. Shin, M. J., & Lee, H. R. (2010). The validity of the TTFC-K for preschool children. Korean Journal of Communication Disorders, 15, Song, K., Kwon, S., & Lee, J. (2013). The effect of working memory training using a software program for working memory and pre-frontal lobe activation in the children with ADHD. Korea Journal of Learning Disabilities, 10, Spaulding, T. J. (2010). Investigating mechanisms of suppression in preschool children with specific language impairment. Journal of Speech, Language, 483

16 Shinyoung Kim, et al. Working Memory Intervention for Children with Delay in Vocabulary Development and Hearing Research, 53, Stark, R. E., & Tallal, P. (1981). Selection of children with specific language deficits. Journal of Speech and Hearing Disorders, 46, Steckol, K. F., & Leonard, L. B. (1979). The use of grammatical morphemes by normal and language-impaired children. Journal of Communication Disorders, 12, Swanson, H. L. (2003). Age-related differences in learning disabled and skilled readers working memory. Journal of Experimental Child Psychology, 85, Swanson, H. L., & Howell, M. (2001). Working memory, short-term memory, and speech rate as predictors of children s reading performance at different ages. Journal of Educational Psychology, 93, Swanson, H. L., & Sachse-Lee, C. (2001). A subgroup analysis of working memory in children with reading disabilities. Domain-general or domainspecific deficiency? Journal of Learning Disabilities, 34, Tomblin, J. B., Mainela-Arnold, E., & Zhang, X. (2007). Procedural learning in adolescents with and without specific language impairment. Language Learning and Development, 3, Ullman, M. T., & Pierpont, E. I. (2005). Specific language impairment is not specific to language: the procedural deficit hypothesis. Cortex, 41, Waters, G. S., & Caplan, D. (1996). The capacity theory of sentence comprehension: critique of Just and Carpenter (1992). Psychological Review, 103, Weismer, S. E. (1996). Capacity limitations in working memory: the impact on lexical and morphological learning by children with language impairment. Topics in Language Disorders, 17, Weismer, S. E., & Evans, J. L. (2002). The role of processing limitations in early identification of specific language impairment. Topics in Language Disorders, 22, Weismer, S. E., Evans, J., & Hesketh, L. J. (1999). An examination of verbal working memory capacity in children with specific language impairment. Journal of Speech, Language, and Hearing Research, 42, Williams, D. L., Goldstein, G., & Minshew, N. J. (2006). The profile of memory function in children with autism. Neuropsychology, 20, Wulfeck, B. B. (1993). A reaction time study of grammaticality judgments in children. Journal of Speech, Language, and Hearing Research, 36, Yang, Y., Yim, D., Kim, S., & Han, J. (2013). The relationship among receptive vocabulary, non-word repetition, and quick incidental learning in preschoolers with and without delay in vocabulary development. Communication Sciences & Disorders, 18,

17 어휘발달지체아동을대상으로한작업기억중재가작업기억및언어능력에미치는영향 김신영외 Appendix 1. 중재어휘목록 동물곤충채소, 곡물과일음식사람장소의류, 장신구신체자연가구가전제품물건탈것운동기타 닭, 부엉이, 비둘기, 참새, 오리, 펭귄개, 고양이, 곰, 기린, 돼지, 말, 사슴, 사자, 호랑이여우, 염소, 원숭이, 코끼리, 토끼, 하마, 소, 양, 쥐거북이, 공룡, 악어, 뱀, 개구리 개미, 나비, 벌 감자, 고구마, 당근, 무, 배추, 호박, 콩, 밤, 쌀 감, 딸기, 메론, 바나나, 배, 복숭아, 오렌지, 토마토, 귤, 수박, 포도 라면, 김밥, 짜장면, 햄버거, 피자, 핫도그, 스파게티, 샌드위치국, 밥, 빵, 떡, 김치, 계란, 생선, 고기, 김, 닭고기물, 우유, 콜라, 주스, 사이다설탕, 소금, 치즈, 껌, 사탕, 초콜릿, 케이크, 도넛, 아이스크림 가수, 간호사, 의사, 선생님, 학생, 군인, 요리사고모, 엄마, 아빠, 삼촌, 누나, 동생, 언니, 오빠, 이모, 형, 할머니아기, 아들, 딸, 여자, 남자, 아저씨, 아줌마, 어른, 어린이, 친구 가게, 유치원, 은행, 수영장, 아파트, 약국, 시장, 서점, 슈퍼마켓목욕탕, 동물원, 도서관, 병원, 박물관, 회사, 학교, 집, 공원부엌, 방, 화장실 바지, 치마, 팬티, 잠바, 잠옷, 양말, 신발, 구두, 운동화가방, 허리띠, 장갑, 목도리, 안경, 지갑, 우산, 모자, 목걸이 가슴, 귀, 눈, 목, 발목, 배, 배꼽, 손가락, 발어깨, 얼굴, 엉덩이, 입, 허리, 팔, 턱, 등, 코 강, 하늘, 해, 비, 불, 별, 달, 눈숲, 잔디, 산, 길, 바람, 모래, 돌, 땅꽃, 나무 식탁, 소파, 피아노, 침대, 의자, 옷장 세탁기, 에어컨, 전화, 청소기, 카메라, 라디오, 핸드폰, 텔레비전, 전자레인지 숟가락, 젓가락, 수건, 휴지, 포크, 치약, 칼, 접시, 쟁반, 쓰레기통상자, 비누, 병, 달력, 걸레, 빗자루, 옷걸이, 빗, 거울, 못, 열쇠공책, 지우개, 편지, 가위, 종이, 블록, 비눗방울, 크레파스, 시계 비행기, 유모차, 자전거, 트럭, 버스, 배, 기차, 헬리콥터, 오토바이 태권도, 축구, 수영, 야구 돈, 그네 485

18 Shinyoung Kim, et al. Working Memory Intervention for Children with Delay in Vocabulary Development Appendix 2. 중재그림자료의예 486