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언어치료연구, 제23권제3호 Journal of Speech-Language & Hearing Disorders http://www.ksha1990.or.kr/ 2014, Vol.23, No.3, 113 ~ 128 http://dx.doi.org/10.15724/jslhd.2014.23.3.010 자폐스펙트럼장애학생의읽기중재실태및인식 : 언어재활사를중심으로 Status and Perception on Reading Intervention for Students with Autism Spectrum Disorders: Focused on Speech Language Pathologists 이미경 1) Mi Kyung Lee < Abstract > Purpose: Students with Autism Spectrum disorders are good at decoding, but have difficulties with reading comprehension. Reading ability is essential for academic achievement in the future. SLP's also must consider how to help these students with their academic success. Thus, the aim of this study is to determine how SLPs can intervene in the students' reading and identify a proper reading intervention strategy which can be used to help SLPs teach ASDs how to read. Methods: A questionnaire survey was reviewed by experts. Then, a preliminary survey was conducted with 5 SLPs who work in Jeonnam province. The final survey was distributed to 153 SLPs nationwide. Results: SLPs taught literacy instruction mostly to students with autism spectrum disorders. They also devoted much time on teaching reading comprehension. SLPs focused primarily on teaching activating back-ground knowledge and vocabulary. They also recognized that they lack sufficient knowledge about students with Autism Spectrum disorders to teach reading. They also showed positive recognition on questions suggesting that reading gets meaning from text. Conclusions: SLPs devote much effort to teach ASDs how to read and comprehend the text. However, these SLPs found it difficult to teach them how to read. Keywords: Autism spectrum disorders, reading intervention status, reading intervention perception, SLPs Ⅰ. 서론 읽기는모든형태의사고나평가, 판단, 상상, 추론외의문제해결까지포함하는높은수준의지적과정이며, 아주복잡한구조를지니고있다 ( 김정미, 윤혜련, 이윤경, 2008). 이러한특성을지닌읽기를잘하기위해서는언어능력이뒷받침되어야한다. 이는곧텍스트를읽고의미를이해하는과정은구어를이해하는데요구되는언어의내용, 형식, 사용에대한모든언어적지식이필수적으로갖추어져야한다 This work was supported by National Research Foundation of Korea Grant funded by the Korean Government (NRF-2013S1A5A8023211). 1) Speech pathology, Dong Shin University Received August 28, 2014 Revision received Setember 25, 2014 Accepted September 26, 2014 는것을의미하기도한다 (Paul, 2003). 읽기이해의과정또한담화를이해하는것과같아 (Gerber, 1993), 일단텍스트가해독되면메시지는구어가입력되는것과동일한인지적처리과정을거친다. 그러므로담화이해능력이부족한언어장애학생들은문어능력에서도제한을지닐수밖에없다. 이외기초적인어휘능력이아주빈약하다면텍스트에제시된많은단어들을인지하고연관시키지못할것이며, 단어해독이가능하다할지라도텍스트를잘이해하지못할것이다 (Paul, 2003). 또한언어장애학생들의전반적인언어능력의부족은읽기에필요한메타언어기술사용의제한을가져오며, 이들의늦은정보처리속도는읽기어려움을초래한다 (Lee & Lee, 2005). 이와같은어려움은이들이학령기에접어들면또래와의학습에서많은차이를가져오게하는원인으로작용할수있다. 학령기는또래와의의사소통및학교에서의학업이더욱중요하므로, 무엇보다교과학습의중요성이더욱강조되고, 저학년에학습한문어기술을바탕으로더욱심화된학습으 113

114 언어치료연구 ( 제 23 권제 3 호 ) 로나아간다 (Heo et al., 2011). 이에따라학령기는말하기, 듣기능력과더불어학습을위한언어능력과상위언어기술, 읽기나쓰기와같은문어기술이더욱중요한역할을한다 (Lee, 2006). 이는곧언어재활사또한학령기아동들의언어발달증진과더불어언어장애아동들의학습증진을도울수있는방향에대한고민이필요하다고할수있다. 이러한필요성에부합하듯이최근언어장애분야또한학령기언어장애학생에대한연구가활발히이루어지고있다. 학령기언어장애는구어에장애를지니고있는경우와더불어학습에문제를갖거나, 혹은학령기에습득하게되는읽기나쓰기와같은언어영역에서문제를보이는이들을포함한다 (Wallach & Butler, 1994). 현재우리나라특수교육대상학생들중에서 70% 에해당되는학생들이통합교육환경에포함되어교육을받고있으며 (Ministry of Education, 2010), 교육및임상현장에서학령기언어장애학생들이차지하는비율또한점차적으로높아지고있는추세이다 (Kim & Hwang, 2013). 특수교육현장에서특수학급에입급되어교육을받는학령기장애학생들중에서지적장애와지체장애학생의수다음으로많은비중을차지하는것이자폐스펙트럼장애학생이다 (Korea national institute for special education, 2013). Kim과 Hwang,(2013) 의연구에서도현재언어재활서비스를받고있는학생들의장애유형은지적장애다음으로자폐스펙트럼장애학생의비율이높은것으로나타났다. 일반적으로자폐스펙트럼장애학생의언어적중재는읽기증진능력등의문해력보다의사소통결함에따른의사소통기능증진에많은중점을두었다. 이는문법적으로오류가없는유창한발화를하는고기능자폐스펙트럼장애학생일지라도하더라도의미적 화용적결함으로인해타인과의의사소통에더욱많은어려움을겪기때문이다 (Choi et al., 2012). 이에따라언어재활사는자폐스펙트럼장애학생이지니고있는핵심적인결함에기초하여이들의삶의질향상을위한구어 / 언어서비스제공에많은중점을두었다. 그러나자폐스펙트럼장애학생또한질적으로높은삶의질을유지하기위해서는의사소통의증진과더불어읽기능력의증진을통한학습능력의배양이필요하다. 특히 21세기는정보화사회로써텍스트에제시된내용에대한이해와더불어여러가지정보매체를통해제공되는내용에대한이해가많이요구되는사회이다. 이러한시대적변화를고려해본다면언어재활사또한자폐스펙트럼장애학생의의사소통능력과더불어문해능력을향상시킬수있는방향에대한탐색이필요하다고할수있다. 즉, 언어발달의전문가로써언어재활사는읽기교수를위한통합적접근에서중요한역할을해야하는것이다 (Paul, 2003). 자폐스팩트럼장애학생은언어와읽기이해력습득의어려움을지니며일부자폐스펙트럼장애학생들은읽기기제를습득하지못한다. 또한일부표준화된읽기검사의하위영역에서의수행이떨어지는결과를나타내어실제그들의읽기능력을예측하기가쉽지않다 (Mayes & Calhoun, 2003a, 2003b). 비록인지기능이좋은고기능자폐스펙트럼장애학생일지라도낱말재인에는어려움을보이지않는반면읽기이해에서는어려움을보인다 (Myles et al., 2002; O' Corner & Klein, 2004; Snowling & Firth, 1986). 구어능력이좋은고기능자폐스펙트럼장애학생들또한인지기능이같은학생들과비교해서단어재인에비해읽기이해능력이떨어진다 (Chiang & Lin, 2007; Nation et al., 2006). 이외에도 Goldstein 등 (1994) 의연구를통해자폐스펙트럼장애학생의학업성취결과를표준화된정상규준과비교한결과저학년고기능자폐스펙트럼장애학생의경우는일반아동과유사한결과가나타났으나청소년기에들어선학생들은점차낮은수행을보였다고보고하였다. 이와같은자폐스펙트럼장애학생의읽기이해의어려움은문맥에서제시된정보통합의어려움 (Firth, 2003), 언어와구어능력의부족 (Mirenda & Erickson, 2000), 의사소통의결여 (Nation & Norbury, 2005) 와일반적인언어능력의부족 (Tager-Flusberg & Joseph, 2003) 등에서비롯된다. 이러한자폐스펙트럼장애학생의읽기특성은현장에서이들을지도하는언어재활사로하여금읽기지도에있어많은어려움을겪게하는하나의원인으로작용할수있다. 비록이러한어려움은있지만자폐스펙트럼장애학생또한읽기영역의교수를통해이득을볼수있는집단이므로 (Williamson et al., 2012) 이들의읽기능력증진또한언어재활사가비중을두고서중재를해야할부분이라할수있다. 미국언어청각협회 (American Speech Language Hearing Association, ASHA) 에서출판된문헌들에의하면언어재활사의핵심적역할은자폐스펙트럼장애학생의판별, 진단, 사회적의사소통의발달, 삶의질을강화하는데있어중요한역할을해야한다는것을밝히고있다 (Plumb & Plexico, 2013). ASHA 에서또한구어는읽기와쓰기발달의기초를이루며, 구어와문어의발전은언어와문해능력의발전을이끌므로아동기부터시작하여청소년까지지속적인서비스를제공해주는것이언어재활사의역할이라고밝히고있다. 즉이제는이전의언어발달증진에초점을둔언어재활서비스에서학업능력증진을위한서비스로확장될필요성이있다고할수있다 (Kamhi et al., 2001). 이는자폐스펙트럼장애학생의경우도예외없이적용되어야하는부분이라할수있다. 이를위해서는현재언어재활서비스를제공하고있는언어재활사를대상으로자폐스펙트럼장애학생의읽기중재

자폐스펙트럼장애학생의읽기중재실태및인식 115 에대한인식은어떠하며, 읽기중재는어떻게실시를하고있는가등을조사하여앞으로학령기자폐스펙트럼장애학생의읽기중재를위한방향성을제시할필요성이있다. 이에따른연구문제는다음과같다. 첫째, 자폐스펙트럼장애학생의읽기중재에대한언어재활실태는어떠한가? 둘째, 자폐스펙트럼장애학생의읽기중재에대한언어재활사의인식은어떠한가? 1. 연구대상 Gender Age Career Ⅱ. 연구방법 본연구는전국의사설치료실에근무하고있는언어재활사를대상으로실시하였다. 언어치료실은전국언어치료협의회에등록되어있는치료실중에서무작위로추출하였으며, 설문응답자는 1급혹은 2급언어재활사자격증을소지하고있는자로한정하였다. 설문에응답한언어재활사의인구사회학적특성은표 1 과같다. 이를요약하면여성이 144명 (94.1%) 이대부분을차지하고있었으며, 1급자격증소지자는 44명 (28.8%) 이었으며, 2급자격증소지자는 109명 (71.2%) 로상당부분 2급자격증을지닌이들이많았다. 치료경력은 2년미만이 45명 (29.4%), 5년미만이 41명 (26.8%), 9년미만이 24명 (15.7%), 10년이상이 43명 (28.1%) 으로나타났다. 치료유형은읽기와쓰기지도를같이하는경우가 104명 (68%) 로가장높은비율을차지하는것으로나타났다. 교육경력에있어대학을졸업한언어재활사가 93명 (60.8%) 으로가장높았으며, 다음으로대학원을졸업한언어재활사가 51명 (33.3%), 전문대학을졸업한언어재활사는 9명 (5.9%) 으로나타났다. 표 1. 연구대상의인구사회학적특성 Table 1. Sociology of Population characteristics Classification N % Male 9 5.9 Female 144 94.1 the twenties 79 51.6 the thirties 31 20.3 the forties 34 22.2 the fifties 9 5.9 Less than 2years 45 29.4 5years 41 26.8 9years 24 15.7 more than 10years 43 28.1 License Taking literacy class academic ability area 1st SLP 44 28.8 2nd SLP 109 71.2 Yes 91 59.5 No 62 40.5 college 9 5.9 university 93 60.8 graduate university 51 33.3 kyounggi providence 32 21 chung chung providence 3 2 Gyeongsang Provinces 73 47,7 Jeolla Province 21 13.7 Kangwen providence 24 15.6 Total 153 100 언어재활사들이지도를많이한장애영역의결과는표 2 와같다. 언어재활사들은언어발달장애 93명 (30.4%), 지적장애 81명 (26.5%), 자폐스펙트럼장애 67명 (21.9%) 의순으로중재를많이한것으로나타났다. 표 2. 중재를많이실시한장애영역 Table 2. The most commonly taught disabilities types Most common disabilitie s taught Classification N % case% Language developmental 93 30.4 60.8 disorder Intellectual Disabilities 81 26.5 52.9 Autism Spectrum Disorders 67 21.9 43.8 Articulation phonology Disorders 43 14.1 28.1 Specific language disorders 9 2.9 5.9 Fluency Disorders 5 1.6 3.3 ADHD 4 1.3 2.6 Physical Disabilities 2 0.7 1.2 Multi cultural children 1 0.3 0.7 Voice disorder 1 0.3 0.7 Total 153 100 200 2. 조사도구및분석방법 본연구에서사용된설문지의주요내용은표 3과같다. 연구의목적에따라자폐스펙트럼장애학생의읽기지도에대한언어재활사의실태및인식을알아보기위하여구성하였으며, 설문지개발절차는다음과같다. 첫째, 설문지구성을위하여읽기교육전반및자폐스펙트럼장애학생의읽기교수에관한문헌들 Kim 등 (2006), Ellery(2009), Marz 등 (2007), Snow 등 (2005), Whalon과 Hart(2011) 을참조하여 1차설문의문항을구성하였다.

116 언어치료연구 ( 제 23 권제 3 호 ) 둘째, 개발된설문지의내용및구성의타당도를검증받기위해 1급언어치료사자격증을소지하고있는 3명의전문가및언어장애를가르치고있는대학교수 1인으로부터검증을받았다. 그후명확하지않는표현, 용어의통일성등에대한지적을받은후이를수정하여반영하였다. 셋째, 설문지개발의최종단계로전라남도에서근무하는언어재활사 5인을대상으로예비조사를실시하였으며그결과를토대로문항을수정 보완하여최종설문지를완성하였다. 표 3. 설문지문항내용과척도 Table 3. Major contents and scales of questionnaire Item Basic Informatio n Practices in reading instruction Awareness on reading 3. 연구절차 contents gender, age, career, license, taking literacy class in Academy, academy ability, working area, most common disabilities taught status of reading intervention strategy status of reading comprehension intervention strategy practices evaluation on reading awareness on reading intervention awareness on reading comprehension intervention Number of questionnaire/ type 9/choice or fill in 4/choice 14/choice 1/choice 5/ 5 likert scale 7/5 likert scale awareness on difficulties of reading intervention and needed 3/choice supports Total 43 본연구를위해한국언어재활사협회홈페이지에기재되어있는기관의홈페이지를통하여주소, 전화번호를수집하였다. 수집된정보를바탕으로각기관의원장님또는언어치료사에게연구취지를설명하고우편및이메일로 200 부의설문지를배포하였다. 배포된 200부의설문지중에서 159부가회수되었으며, 회수율은 76.5% 였다. 회수된설문지중에서문항체크가불성실하게되어있는설문지를제외하고총 153부의설문지를분석하였다. 4. 자료분석 응답자의인구사회학적에관련된특성을알아보기위해기술통계를사용하여빈도와백분율을산출하였다. 자폐스펙트럼장애학생의읽기중재실태및인식은각문항별로빈도와백분율을산출한후제시한후인구사회학적변인 ( 자격 증급수, 문해교육수강여부, 경력 ) 에따른차이는 SPSS 21.0 을사용하여 t-test와 one-way ANOVA를실시하였다. Ⅲ. 연구결과 1. 언어재활사의자폐스펙트럼장애학생의읽기중재실태 1) 자폐스펙트럼장애학생의읽기중재실태자폐스펙트럼장애학생의읽기중재실태는표 4와같다. 언어재활사가실시하고있는주요중재유형은읽기와쓰기 (64.7%) 가가장많은것으로나타났다. 읽기중재시가장많이활용하고있는자료는그림책또는이야기책 (28.1%), 스스로제작한학습지 (21.9%) 의순으로나타났다. 책을읽고난뒤의이해력점검활동으로는자폐스펙트럼장애학생과의문답법을통해주요내용에대한점검하기방법 (71.2%) 을가장많이적용하는것으로나타났다. 읽기의여러가지영역중에서가장많은중재를하고있는것은읽기이해력 (61.4%) 으로나타났다. 2) 자폐스펙트럼장애학생의읽기이해력중재및평가실태자폐스펙트럼장애학생의읽기이해력중재및평가에대한실태는표 5와같다. 연구결과자폐스펙트럼장애학생의읽기이해력지도를위한교수전략으로배경활성화에대한교수는자주시행한다 (39.2%) 가제일많았으며, 어휘력증진에대해서도자주시행한다 (59.5%) 가많았다. 이외에도줄거리요약활동 (53.6%), 주요아이디어찾기 (54.9%), 사실적질문에대답하기 (59.5%), 학생의의사소통능력을고려하여활동기반의활동하기 (59.5%), 음운인식적용하기 (58.2%), 책을읽을때자폐스펙트럼장애학생의사전경험연결시키기 (58.2%), 기존지식과의연결 (61.4%), 책을읽고난뒤에요약하기및질문하기 (54..2%) 도자주실시하는것으로나타났다. 이에반해읽기유창성지도 (55.6%) 와진전도점검한다 (39.2%) 는문항에는약간실시하고있는것으로나타났다. 3) 인구사회학적특성에따른읽기이해력중재및평가실태차이인구사회학적특성에따른읽기이해력중재및평가의차이는표 6과같다. 읽기이해력중재및평가는대학또는대학원에서의문해교육관련수강여부에따라서유의미한차이는나타나지않았다. 또한자격증에따라서도유의미한차이가나타나지

자폐스펙트럼장애학생의읽기중재실태및인식 117 표 4. 자폐스펙트럼장애학생의읽기중재실태 Table 4. Status of reading intervention for ASD students Items Sub items Frequency (N) Rate(%) Major instruction type Commonly used materials for teaching reading Reading comprehension monitor after reading books What focuses most on teaching reading Reading instruction 47 30.7 Writing instruction 7 4.6 Reading and writing instruction 99 64.7 Text book 34 11.1 Study materials invented by oneself 67 21.9 Internet and audiovisuals media 23 7.5 Picture and letter cards 62 20.3 Play or game materials 19 6.2 Picture book or story book 86 28.1 Materials related real life situation 15 4.9 SLP summarize major phrase or sentences. paragraphs' meaning 20 13.1 Discussion with ASD students after reading 9 5.9 Checking on major issues by asking questions and answer method with ASD students. 109 71.2 Using strategies which are needed for reading comprehension 15 9.8 Sight word reading 11 7.2 Reading fluency 3 2.0 Phonological awareness 7 4.6 Vocabulary 39 24.8 Reading comprehension 94 61.4 TOTAL 143 100 표 5. 자폐스펙트럼장애학생읽기이해력중재및평가실태 Table 5. Status of reading comprehension intervention and evaluation for ASD students Item Sub-items Never done A little done Frequently done Very frequently done N(%) N(%) N(%) N(%) Teaching back-ground activation 7(4.6) 79(51.6) 60(39.2) 7(4.6) Focusing on vocabulary increasing 1(0.7) 34(22.2) 91(59.5) 27(17.6) Summarizing plot activities 8(5.2) 46(30.1) 82(53.6) 17(11.1) Finding main idea 2(2.0) 37(24.2) 84(54.9) 29(19.0) Answering literal questions 4(2.6) 27(17.6) 91(59.5) 31(20.3) Answering inferential questions 8(5.2) 63(41.2) 62(40.5) 20(13.1) Reading Teaching sentence structure 26(17.0) 60(39.2) 59(38.6) 8(5.2) comprehention Doing activity based lesson with considering students' communication skills 2(1.3) 30(19.6) 91(59.5) 30(19.6) intervention Focusing on understanding contents interpreting textbook by 19(12.4) 65(42.5) 62(40.5) 7(4.6) Applying phonological awareness 57(37.5) 56(36.6) 67(43.8) 29(19.0) Teaching reading fluency 40(26.2) 85(55.6) 25(16.3) 3(2.0) Trying to teach ASD students connect to theirs prior experiences when read books 2(1.3) 48(31.4) 89(58.2) 14(9.2) Trying to teach ASD students connect to theirs existing experiences when read books 6(3.9) 42(27.5) 94(61.4) 11(7.2) Teaching to predict through summarizing after reading a book questioning, 9(5.9) 46(30.1) 83(54.2) 15(9.8) Evaluation Monitoring progress 26(17.0) 60(39.2) 59(38.6) 8(5.2)

118 언어치료연구 ( 제 23 권제 3 호 ) 않았다. 그러나언어재활의경력에따라서는통계적으로유의미한차이가나타났다 (F=3.331, P=.021). Scheffe 사후검증결과경력 2년이하의언어재활사보다경력 10년이상의집단에서유의한차이가나타났다. 이는곧경력이많은언어재활사들이읽기이해력중재에더많은비중을둔다고해석할수있다. 표 6. 인구사회학적특징에따른읽기이해력중재및평가차이 Table 6. The difference reading comprehension intervention and evaluation according to sociology of population Variables Items (N) M(SD) F/t p Taking Yes(91) 3.3(.31) literacy.674.501 class No(62) 3.2(.32) SLP licence Career 1 level(44) 3.2(.32) 2 level(109) 3.3(.27) 2years (45) 5years (41) 9 years (24) more than 10years (43) 3.2(.32) 3.3(.30) 3.3(.34) 3.4(.28) -1.718.088 3.331.021 2. 자폐스펙트럼장애학생의읽기중재에대한언어재활사의인식 1) 자폐스펙트럼장애학생의읽기및읽기이해력중재의어려움에대한언어재활사의인식자폐스펙트럼장애학생의읽기및읽기이해력중재의어려움에대한언어재활사의인식은표 7과같다. 연구결과읽기는텍스트로부터의미를얻는다는것에그렇다는인식이 60.1% 로가장높았으며, 다음으로는매우그렇다가 22.9% 로나타났다. 읽기교육의목표는읽기능력을향상시키는것이라는항목에보통이다 (41.2%) 가가장많았으며, 다음으로는그렇다 (35.3%) 가높았다. 소리내어책읽기는읽기에필요한지식과기술을쌓는데효과적이라는것에는보통이다 (52.3%) 가가장높았으며, 그렇다 (32.7%) 가다음순으로높게나타났다. 음운인식을가르치는것이아동의읽기및쓰기를위한기초를제공한다는항목에대해서는그렇다 (51.6%) 가가장높게나타났으며, 다음으로는매우그렇다 (28.8%) 의순으로나타났다. 읽기교수는자폐스펙트럼장애학생의언어기술을향상시킨다는문항에대해서는그렇다 (45.1%), 보통이다 (43.8%) 의순으로나타났다. 자폐스펙트럼장애학생의읽기이해력중재의지도에대한언어재활사의인식을살펴보면이야기구조에대한민감성부족으로인한것이라는문항에대하여그렇다 (47.7%), 다음으로는보통이다 (37.3%) 의순으로나타났다. 추론능력의부족으로읽기이해력중재의어려움을가져오는원인이라는문항에대해서는그렇다 (63.4%) 가가장높았으며, 다음으로는매우그렇다 (20.3%) 의순으로나타났다. 읽고있는것에대한모니터링능력의부족으로인한것이라는문항에대해서는그렇다 (63.4%), 보통이다 (26.1%) 의순으로높게나타났다. 다른사람의의도및감정에대한이해의부족이읽기이해력중재의어려움을초래하는원인이된다는문항에대해서는그렇다 (54.2%), 매우그렇다 (22.9%) 의순으로나타났다. 2) 자폐스펙트럼장애학생의읽기문제및지원에대한언어재활사의인식자폐스펙트럼장애학생의읽기문제및지원에대한언어재활사의인식은표 8과같다. 연구결과언어재활사들은자폐스펙트럼장애학생의읽기문제는장애자체떄문이라는인식이 43.1% 로가장많았으며, 다음으로는자폐스펙트럼학생들의수준에적합한교수를받지못해서가 42.5% 인것으로나타났다. 자폐스펙트럼장애학생의읽기교수에대한지식에대한문항에서 45.1% 에해당되는언어재활사는가르치기에충분한지식을지니지않고있다고인식하고있었으며, 충분하지는않지만가르치기에는충분한지식을가지고있다가 35.9% 로다음으로높게나타났다. 자폐스펙트럼장애학생의읽기지도를효율적으로지도하기위해가장필요한것은학생들의수준에적합한교재와자료의개발이 39.3% 로가장높았으며, 다음으로높은것은읽기교수를위해언어재활사의자질향상이필요하다 (26.8%) 는것으로나타났다. 3) 인구사회학적특성에따른읽기및읽기이해력에대한언어재활사의인식차이인구사회학적특성에따른자폐스펙트럼장애학생의읽기및읽기이해력에대한언어재활사의인식의차이는표 9 와같다. 우선읽기에대한인식에있어문해교육수강여부는유의미한차이가없었다. 또한자격증급수에따라서도읽기인식에서유의미한차이가나타나지않았으며, 경력에따라서도유의미한차이가나타나지않았다. 자폐스펙트럼장애학생의읽기이해력교수에대한언어재활사의인식은대학또는대학원에서의문해교육수강여부에따라서는유

자폐스펙트럼장애학생의읽기중재실태및인식 119 표 7. 자폐스펙트럼장애학생의읽기및읽기중재의어려움에대한언어재활사의인식 Table 7. SLP's awareness on reading and difficulties of reading intervention for students with ASD reading problems Item Awareness on reading Awareness on reading comprehen sion Sub-contents Never Not really Average A little agree Strongly agree N(%) N(%) N(%) N(%) N(%) Reading is to get the meaning from printed text 1(0.7) 4(2.6) 21(13.7) 92(60.1) 3522.9) The aim of reading education is to improve reading ability 1(0.7) 25(16.3) 63(41.2) 54(35.3) 10(6.5) Reading aloud with ASD is an effective way on building knowledge and skills to read books 1(0.7) 13(8.5) 80(52.3) 50(32.7) 9(5.9) Teaching phonological awareness works as a basic skill for reading and writing 0 0 30(19.6) 79(51.6) 44(28.8) Teaching reading improves language skills 0 8(5.2) 67(43.8) 69(45.1) 9(5.9) Lacking of sensitivity to story structure causes difficulty for SLPs on intervening of reading comprehension toward them Lacking of inference abilities cause difficulty for SLPs on intervening of reading comprehension toward them Lacking of monitoring on what they are reading cause difficulty for SLPs on intervening of reading comprehension toward them Lacking of mind theory causes difficulty for SLPs on intervening of reading comprehension toward them Lacking of other's intention and feeling causes difficulty on intervening of reading comprehension toward them Computer based video instruction is an effective way to improve reading comprehension Using mass-media is an effective way to improve reading comprehension 0 16(10.5) 57(37.3) 73(47.7) 7(4.6) 0 2(1.3) 23(15.0) 97(63.4) 31(20.3) 0 4(2.6) 4026.1) 97(63.4) 12(7.8) 1(0.7) 5(3.3) 41(26.8) 79(51.6) 27(17.6) 0 5(3.3) 30(19.6) 83(54.2) 35(22.9) 0 27(17.6) 88(57.5) 34(22.2) 4(2.6) 1(0.7) 16(10.5) 69(45.1) 57(37.3) 10(6.5) 표 8. 자폐스펙트럼장애학생의읽기문제및지원에대한언어재활사의인식 Table 8. SLP's awareness on reading problems of ASD and needed supports Item Sub contents Frequency (N) Rate(%) What caused ASD's reading problems SLP's Knowledge to teach reading for ASD What needed most on the effective reading instruction for ASD Cause of disabilities 66 43.1 Lack of instruction at home 8 5.2 Not enough materials for student's level 14 9.2 Were not taught suitable instruction for them 65 42.5 Not enough material at work place 0 0 Have enough knowledge to teach 2 1.3 Not enough knowledge but good enough to teach 55 35.9 Do not have enough knowledge to teach 69 45.1 Knowledge is so poor, so needs to be educated necessary and essential skills 27 17.6 Improving SLP's professional qualification on reading instruction 41 26.8 Arranging environment for reading instruction at home or school 25 16.3 Developing reading text books and materials for classified students level 61 39.9 Evidence based reading instruction 26 17.0 Total 153 100

120 언어치료연구 ( 제 23 권제 3 호 ) 표 9. 인구사회학적변인에따른읽기및읽기이해력에대한언어재활사의인식차이 Table 9. The difference awareness on reading and reading comprehension of SLPs according to sociology of population Classi ficati on Awar eness on read ing Awar eness on read ing compr ehensi on Variables Items (N) M(SD) F/t p Taking literacy class SLP licence Career Taking literacy class SLP licence Career Yes(91) 3.7 No(62) 3.6 1st grade(44) 2nd grade (109) 2years (45) 5years (41) 9 years (24) more than 10years (43) 3.6 3.7 3.6(.45) 3.6(.36) 3.6(.40) 3.7(.47) Yes(91) 3.7(.36) No(62) 3.6(.50) 1st grade(44) 2nd grade (109) 2years (45) 5years (41) 9 years (24) more than 10years (43) 3.8(.35) 3.6(.43) 3.6(.44) 3.5(.34) 3.7(.49) 3.8(.38).726.469-1.167.245.568.637.934.322-3.558.000 3.818.011 의미한차이가나타나지않았다. 그러나자격증 (t=-3.558, p<.001) 및경력 (F=3.818, p<.05) 에따라유의미한차이가나타났다. Scheffé 사후검증결과 3-5년집단과 10년이상의경력을지닌집단에서유의한차이가나타났다. Ⅳ. 논의및결론 1. 자폐스펙트럼장애학생의읽기중재실태언어재활사들은자폐스펙트럼장애학생을대상으로문해중재를많이실시하고있는것으로나타났다. 이와같은결과는특수학급아동의방과후언어치료실태를조사한결과읽기와쓰기가 2순위로중재분야에포함되어있는것 (Kim, 2010) 과일치한다고할수있다. 또한문해중재에많은비중을두고있는결과는다음과같은배경에서살펴볼수있다. Park(2013) 은학령기의사소통장애및언어치료에대한초등학교교사들의인식을조사하였으며, 그결과교사들은장애학생들이국어교과를가장어려워한다고보고하였다. 국어교과는다른교과보다언어적인능력이많이요구되는교과이며, 다른교과학습의기초를이루는과목이다. 국어교과의부분을이루는읽기와쓰기는상호관련성을지니는처리과정으로한가지활동의참여는다른하나의발전을강화시켜준다 (Pierce & Poeter, 1996). 이러한측면에서볼때언어재활사들은자폐스펙트럼장애학생의언어능력의증진과더불어학교에서의학업능력증진을위해문해학습에많은비중을두고지도하고있다고할수있다. 또한문해지도를많이실시하고있다는것은언어재활사의역할이장애학생들을대상으로한언어중재를넘어능숙한독자, 쓰기과정, 세상사지식, 문장구조, 구어와문어의상호성과문해발달증진을위한역할과책임을수행하는것까지확대되어실시되고 (ASHA, 2003) 있다는것을반영하는결과라할수있다. 읽기영역중에서가장많은중재가이루어지고있는부분은읽기이해력으로나타났다. 이와같은결과는다음에따르는자폐스펙트럼장애학생의특성으로인한것이라할수있다, 자폐스펙트럼장애학생에게있어서이해를위한읽기는꽤어려운부분이며 (Randi et al., 2010), 고기능자폐스펙트럼장애학생이더라도문어를이해하는데있어어려움이있는것으로알려져있다 (O'cornor & Hermelin, 1994; Washlberg & Magliano, 2004. 특히자폐스펙트럼장애학생들이지니고있는의사소통, 사회적상호작용, 인지적처리과정의결손의특징 (Randi et al, 2010) 등은텍스트를읽은후의미이해부분에서많은어려움을가져오게하는원인으로작용한다. 이에따라언어재활사들을자폐스펙트럼장애학생의읽기이해력향상을위하여중재할때학생의의사소통능력향상도같이고려하여활동위주의수업및텍스트의정확한해석을통한내용파악에많은중점을두면서읽기이해력향상에많은중점을두고있다고해석할수있

자폐스펙트럼장애학생의읽기중재실태및인식 121 다. 본연구에서자폐스펙트럼장애학생들의읽기이해력을중재할때언어재활사들은사실적질문에답하기를추론적질문에답하기보다많이지도를하는것으로나타났다. 이와같은결과는자페스펙트럼장애학생이언어를문자그대로해석하는특성 (Tager-Flusberg, 1981), 내적인상태를의미하는단어들은이해가능하나, 문맥속에서그들이의미하는바는해석하지못하는특성 (Dennis et al., 2001), 은유와언어적부조리가포함된추론과제측정의어려움 (Minshew et al., 1995, 1997) 으로인한것이라볼수있다. 한편, Kintsch(1988) 에의하면능숙한독자는심도깊게이해하고학생들은사전의지식이나추론을구성하기위해장기기억에존재하는경험을이끌어내텍스트에제시된단어들을보충해낸다. 그러나자폐스펙트럼장애학생들은텍스트에제시된모호한언어를해석하기위해사전지식을활용하는데있어어려움을보이며 (Washlberg & Magliano, 2004), 읽기를하는통안텍스트모니터링에서도한계점을지닌다 (O'connor & Klein, 2004). 이외에도자폐스펙트럼장애학생들은제시된텍스트를해석하기위해사전지식활용에서많은어려움을지닌다. 비록자폐스펙트럼장애학생들이이러한어려움은지니고있지만텍스트읽기와이해능력은학습기회를확장시켜주며또한의사소통능력도향상시켜준다 (Nation & Norbury, 2005). 이에따라언어재활사들은자폐스펙트럼장애학생의읽기이해력능력증진을위해사전경험연결, 기존지식과의연결및책을읽고난뒤요약하기질문하기등에많은중점을두고있다고할수있다. 언어재활사들은학생들의읽기진전에대하여약간실시하고있다는것과중점적으로실시한다가유사한비율로높게나타났다. 이와같은결과는 Kim과 Yoo(2011) 의언어치료의전문성수행을조사한결과수행프로그램에대해체계적인점검과평가를보통이상으로실시하고있다는결과와일치한다고할수있다. 자폐스펙트럼장애학생의읽기평가는현재학생의현수준을정확하게이해할수있도록도와주며치료의진전을파악하고다음의프로그램계획을세우는데있어서도중요한역할을하므로언어재활사들은기존의공식적검사또는비공식적검사도구를활용하여평가를자주실시할필요성이있다. 이를위해서는언어재활사는자폐스펙트럼장애학생의읽기수준을파악하고평가할수있는지식과기술을지니는것 (ASHA, 2006) 이우선시되어야한다고할수있다. 2. 자페스펙트럼장애학생의읽기지도에대한언어재활사의인식 본연구결과언어재활사들은자폐스펙트럼장애학생의읽기지도는이들의언어능력을증진시킨다고인식하고있었다. 능숙한읽기란텍스트에서전달되는의미에대한이해가포함되며성공적인읽기이해력을위해서는언어능력이기초를이루어야한다 (Clarke et al., 2010; Muter et al., 2004). 즉, 언어적능력과읽기이해력의관계는불가분의관계라할수있다. 이에따라언어재활사들자폐스펙트럼장애학생들의읽기지도를통해언어발달능력증진또한가능하다고인식하고있다고할수있다. 읽기를학습하는초기단계에는아동들은단어를읽고, 텍스트를정확하고유창하게연결시킬수있도록단어재인기술을발달시켜야한다 (Ricketts et al., 2013). 단어재인을능숙하게하기위해서는음운론적처리과정이능숙하게이루어져야한다. 특히음운론적처리과정은글자읽기능력을예측하는주요변인이며 (Catts et al., 2002). 쓰기능력과도관련성을지닌다. 이에따라언어재활사는음운인식을가르치는것이아동의읽기및쓰기를위한기초를제공한다는항목에대해서긍정적으로인식을한다고할수있다. 이외에도장애학생들의읽기및쓰기를발전시키기위해언어재활사는그들이지니고있는언어학적지식을바탕으로단어재인을가르치는데있어중요한역할을해야한다는 Kamhi 등 (2001) 의연구결과와도인식을같이한다고할수있다. 언어재활사들은자폐스펙트럼장애학생들이지니는이야기구조에대한민감성과타인의감정을이해하는능력의부족이읽기이해력중재의어려움을야기하는한원인으로인식하고있었다. 이는자폐스펙트럼장애학생들은마음이론의결여로인한이야기텍스트에제시된주인공의감정이나관점을잘이해의어려움, 사전지식활성화의어려움, 새롭게습득한정보들과연결짓기의어려움, 이야기도식적용등에대한어려움 (Cho & Yoon, 2009) 으로인하여학생의사전지식과언어적인부분을연결시켜읽기이해력을지도하는것에어려움을겪고있는그들의인식을반영한다고할수있다 (Wallach, 2014). 본연구에서경력이높은언어재활사집단이읽기이해력지도의어려움에대해더욱많은동의를나타내었다. 이러한결과는언어재활사들의경력이증가됨에따라많은사례를접함으로써자폐스펙트럼에대한이해의폭이넓어진결과라해석해볼수있다 (Plumb & Plexico, 2013). 또한이러한특성은자폐스펙트럼장애학생의읽기지도의실태측면과연계해서살펴볼수있다. 본연구결과경력이더많은집단이읽기지도측면에서도좀더다양한시도를하는것으로나타났다. 이는곧경력의증가로인하여자폐스펙트럼장애학생의개별적특성에대한이해가증가되고, 이에따라이들의읽기능력증진을위해다양한중재를시도하는

122 언어치료연구 ( 제 23 권제 3 호 ) 것으로해석할수있다. 본연구의결과를바탕으로후속연구를위해다음과같이제언하고자한다. 본연구애서자폐스펙트럼장애학생의읽기능력또는학년수준을구체적으로구분짓지않았다. 따라서후속연구에서는학년및읽기능력수준에따른읽기중재의실태를파악한후이에따른중재접근법을구체적으로조사하여제시할필요성이있다. 참고문헌 American Speech and Language-Hearing Association. (2003). Roles and responsibilities of speech language pathologists with respect to reading and writing in children and adolescents. Retrieved form www.ashs.org/policy. American Speech and Language-Hearing Association. (2006). Guidelines for speech-language pathologists in diagnosis, assessment, and treatment of autism spectrum disorders across the life span. Retrieved form www.ashs.org/policy. Catts, H. W., Fey, M. E., Tomblin, J. B., & Zhang, X. (2002). A longitudinal investigation of reading outcomes in children with language impairments. Journal of Speech and Language, and Hearing Research, 45(6), 1142-1157. Chiang, H., & Lin, Y. H. (2007). Reading comprehension instructions for students with autism spectrum disorders: A review of the literature. Journal of Autism and Developmental Disabilities, 22, 259-267. Choi, S., Chon, B. J., & Cheo, H. J. (2012). An inferential ability of adolescents with high-functioning autistic disorders and related factors. Autism Spectrum Disorder Research, 12(1), 1-17. [ 최숲, 정부자, 전희정 (2012). 고기능자폐성장애청소년의추론능력및관련요인. 자폐성장애연구, 12(1), 1-17]. Cho, S, K., & Yoon C. Y. (2009). The effects of story mapping activity on comprehension and reading ability of children with autistic disorder. Psychological and Behavior Research, 1(1), 1-19. [ 조선구, 윤치연 (2009). 스토리맵을활용한동화읽기가자폐성장애아동의회상능력에미치는효과. 심리행동연구, 1(1), 1-19.] Clarke, P. J., & Snowling, M. J., Truelove, E., & Hulme, C. (2010). Ameliorating children's reading comprehension difficulties: A randomized controlled trial. Psychological Science, 21, 1106-1116. Dennis, M., Lazenby, A. L., & Lockyer, L. (2001). Inferential language in high-function children with autism. Journal of Autism Developmental Disorders, 31(1):47-54. Ellery, V. (2009). Creating strategic readers: Techniques for developing competency in phonemic awareness, phonics, fluency, and vocabulary. Newark: International Reading Association. Frith, U. (2003). Autism (2nd ed.). Oxford: Blackwell Gerber, A. (1993). Language-related learning disabilities: Their nature and treatment. Baltimore: Paul H. Brooks. Goldstein, G., Minshew, N. J., & Siegel, D. J. (1994). Age differences in academic achievement in high-functioning autistic individuals. Journal of Clinical and Experimental Neuropsychology, 16, 671-680. Heo, H, S., Kwag, K. M., & Lee, Y. K. (2011). The relationship among the reading and writing abilities and oral language skills of school-aged low-achievers in language learning. Communication an Science Disorders, 16, 23-33. [ 허현숙, 곽경미, 이윤경 (2011). 언어학습부진아동의구어능력과읽기 쓰기능력과의관계. 언어청각장애연구, 16, 23-33.] Kamhi, A. G., Allen, M. M., & Catts, H. W. (2001). The role of the speech-language pathologist in improving decoding skills. Seminars in Speech and Language, 22, 175 183. Kim, E. M. (2010). Actual conditions and problem of after school language therapy for the children in special education classroom. [ 김은미 (2010). 특수학급아동의방과후언어치료실태와문제점. 단국대학교특수교육대학원, 석사학위논문.] Kim, J. H., & Hwang, S. S. (2013). Parents' practies and demands in speech therapy service delivery by age groups. Journal of Speech-Language and Hearing Disorders, 22(1), 273-297. [ 김지현, 황상심 (2013). 자녀연령에따른장애아부모의언어치료실태및요구조사. 언어치료연구, 22(1), 273-297. Kim, J. M., Yun, H. R., & Lee, Y. K. (2005). Language and

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자폐스펙트럼장애학생의읽기중재실태및인식 125 부록 1. 설문지 Ⅰ. 일반적정보 1. 선생님의연령은어떻게되십니까? 1 20대 230대 340대 450 대 2. 선생님의성별은어떻게되십니까? 1남자 2여자 3. 근무하시는지역은어디입니까? 4. 선생님의학위는다음중어디에해당되십니까? 12~3년제대학졸업 24년제대학졸업 3석사이상졸업 5. 언어치료사자격은다음중어디에해당합니까? 1 2급언어치료사 21급언어치료사 6. 임상경력이몇년정도되십니까? ( 년 ) 7. 선생님의근무처는어디입니까? 1 사설치료실 2 병원및의원 3복지관 4통합어린이집 5장애전담어린이집 6일반학교 7특수학교 8교육지원청 9기타 8. 다음의언어치료영역중가장많은치료한영역은어느것입니까? (2가지만선택해주세요.) 1지적장애 2자폐범주성장애 3ADHD 4음성장애 5다문화아동 6유창성장애 7조음음운장애 8단순언어장애 9언어발달장애 10지체장애 9. 장애학생의읽기지도에도움이되는과목을대학또는대학원에서수강한적이있습니까? 1 예 2 아니오 Ⅱ. 자폐스펙트럼장애읽기지도실태 * 10~13 문항의경우해당되는답을한가지만선택해주시기바랍니다. 10. 주로어떤유형의문해교육을하고있습니까? 1 읽기지도 2 쓰기지도 3 읽기 + 쓰기지도 4 기타 11. 읽기지도를위해주로사용하는교재는무엇입니까? 1 교과서 2 직접제작한학습지 3 인터넷및각종시청각자료 ( 비디오, 사진, tv 프로그램, CD 자료 ) 4 그림및글자카드 5 놀이나게임형식의교재교구 6 그림책이나동화책 7 실제생활과관련되는자료 ( 광고지, 우편지, 도로표지판, 잡지등 )

126 언어치료연구 ( 제 23 권제 3 호 ) 12. 책의내용을다읽고난후내용이해활동은어떻게하고계십니까? 1 치료사가구절과문장의의미를해석하고, 단락의의미를정리해준다. 2 치료사가학생에게책을읽게한후에토론을한다. 3 중요한내용을치료사와학생간의문답으로이해하고정리한다. 4 읽은글을이해하는데필요한전략을소개하고훈련을시킨다. 13. 자폐스펙트럼장애학생에게읽기지도를실시하실때많은비중을두고지도하는부분은무엇입니까? 1 일견단어읽기 2 유창성 3 음운인식 4 어휘 5 이해력 자폐스펙트럼장애학생의읽기지도를할때다음에제시된전략및평가를치료시어느정도실시하십니까? 읽기이해력지도전략 1 전혀실시하지않는다. 2 조금실시한다. 3 중점적으로실시한다. 4 매우중점적으로실시한다. 14 배경지식의활성화 15 어휘력향상 16 줄거리요약하기 17 중심내용찾기 18 사실적질문에답하기 19 추론적질문에답하기 20 구문구조지도하기 21 22 의사소통능력향상도같이고려하여활동위주의학습을실시텍스트의정확한해석을통한내용파악에중점을둠 23 음운인식접근방법을적용함 24 읽기유창성을지도함 25 26 27 책을읽을때자신의이전경험과연결시켜이해할수있도록지도함책을읽을때새로운내용을기존의지식과연결할수있도록지도함책을읽고질문하기, 요약하기, 명료화하기를통해자폐스펙트럼장애학생들이다음내용을예측할수있도록지도함 28 읽기진전도평가를정기적으로실시함 Ⅲ. 자폐스펙트럼장애학생의읽기지도인식 * 29~31 의문항의경우해당되는답을한가지만선택해주시기바랍니다. 29. 현재담당하고있는학생들의 읽기 에서문제점을보이는가장큰원인은무엇이라고생각하십니까? 1 장애자체때문이다. 2 가정에서의지도가부족하기때문이다. 3 학생들의수준에적합한학습자료가부족해서이다. 4 읽기지도를적절하게제공해주지못해서이다. 5 치료실에다양한자료가구비되어있지않아서이다.

자폐스펙트럼장애학생의읽기중재실태및인식 127 30. 본인은자폐스펙트럼장애학생들의 읽기 지도를하는데있어필요한지식을어느정도갖추고있다고생각하십니까? 1 필요한모든지식을충분히갖추고있다. 2 충분하지는않지만가르치는데부족함이없을정도로갖추고있다. 3 지도를하는과정에서조금부족함을느낀다. 4 부족함을많이느껴서필요한지식을습득할수있는교육이실시되었으면한다. 31. 자폐스펙트럼장애학생들의효과적인 읽기 지도를위해가장필요한것은무엇입니까? 1 읽기지도를위한치료사의전문성향상 2 가정이나학교에서읽기학습에필요한환경조성 3 학생들의읽기수준에적합하게지도할수있는학습교재및자료개발 4 효과적인결과를가져온다는연구에기초를둔교육프로그램개발 5 기타 ( ) 아래의내용과선생님의견해가일치하는해당항목에 바랍니다. 항 32 읽기 란글속의의미를파악하고해석하는것을의미한다. 33 읽기 교육의궁극적목표는읽기능력을신장시키는것이다. 34 35 36 37 38 39 40 41 42 43 소리내어책읽기는자폐스펙트럼장애학생의읽기에필요한지식과기술을쌓는데효과적이다. 자폐스펙트럼장애학생에게음운인식을가르치는것은읽기및쓰기를위한기초를제공한다. 자폐스펙트럼장애학생에게읽기를가르치는것은언어능력을향상시킨다. 자폐스펙트럼학생은이야기구조에대한민감성이떨어져읽기이해력지도가어렵다 목 자폐스펙트럼장애학생의추론능력의부족으로읽기이해력지도가어렵다. 자페스펙트럼장애학생의읽기모니터링능력의부족으로읽기이해력지도가어렵다. 자폐스펙트럼장애마음이론의결여로인하여읽기이해력지도가어렵다. 다른사람의의도와감정파악의어려움은읽기이해력지도를어렵게만든다. 자폐스펙트럼장애학생의읽기이해력을향상시키기위해서는컴퓨터기반의비디오교수를실행하는것이효과적이다. 자폐스펙트럼장애학생의읽기이해력을향상시키기위해서는멀티미디어를활용하는것이효과적이다. 1 2 3 4 5 매우보통매우아니다그렇다아니다이다그렇다

128 언어치료연구 ( 제 23 권제 3 호 ) 국문초록 자폐스펙트럼장애학생의읽기지도실태및인식 : 언어재활사를 중심으로 이미경 1) 배경및목적 : 자폐스펙트럼장애학생은단어재인에강점을지니는반면, 읽기이해력에많은어려움을겪는다. 자폐스펙트럼장애학생에게있어읽기능력은학업을위해서는필수적이며, 언어재활사또한이들의학업적능력증진을위해고민할필요성이있다. 따라서본연구에서는현재자폐스펙트럼장애학생의읽기중재의실태및이에대한인식을알아보고향후이들의읽기중재를위한방향성을제안하기위해실시되었다. 방법 : 선행연구를참조하여설문을구성한후전문가로부터타당성검증을거쳤다. 그후전라남도에거주하는언어재활사 5인을대상으로예비조사를실시한후최종설문을완성하여전국에있는 153명의언어재활사를대상으로조사를실시하였다. 결과 : 연구결과자폐스펙트럼장애학생을대상으로가장많은비중을두고중재하는분야는문해영역으로나타났으며, 읽기하위영역중에서는읽기이해력을많이중재하고있었다. 읽기중재를위한교수전략으로배경활성화에대한중재및어휘력중재를자주실시하는것으로나타났다. 읽기중재에대한인식에서언어재활사는자폐스펙트럼장애학생의중재를위한교수지식을묻는항목에서충분하지는않다고인식하고있었다. 읽기는텍스트로부터의미를얻는것이라는항목에대해서는긍정적으로인식하고있었다. 논의및결론 : 언어재활사들은자폐스펙트럼장애학생의읽기능력향상을위해많은노력을기울이고있는것으로나타났으나, 읽기이해력지도에많은어려움을겪고있다고할수있다. < 검색어 > 자폐스펙트럼장애, 읽기중재실태, 읽기중재인식, 언어재활사 이연구는 2013 년정부 ( 교육과학기술부 ) 의재원으로한국연구재단의지원을받아수행되었음 (NRF-2013S1A5A8023211) 1) 이미경 ( 제 1 저자, 교신저자 ) : 동신대학교언어치료학과 (amykyung@dsu.ac.kr) 게재신청일 : 2014. 8. 10 수정제출일 : 2014. 9. 25 게재확정일 : 2014. 9. 26