ASD와 기타 신경발달장애 유아의 변별진단에서 지능수준을 통제한 K-Vineland-Ⅱ 잔차 z점수의 유용성

초록

This study aims to explore differences in adaptive behavior profiles between preschoolers with autism spectrum disorder (ASD) and those with other neurodevelopmental disorders (NDD) using Korean Vineland Adaptive Behavior Scales, 2nd Edition (K-Vineland-II) residual z-scores with intelligence level controlled, and to examine the utility of these scores in differential diagnosis. A total of 169 preschoolers aged 3 to 6 years (ASD: n=83; other NDD: n=86) completed the Korean Wechsler Preschool and Primary Scale of Intelligence, Fourth Edition (K-WPPSI-IV) and K-Vineland-II. Linear regression analyses with Full Scale IQ (FSIQ) as the predictor variable were conducted to compute residual z-scores for the Communication, Daily Living Skills, Socialization, Motor Skills, and Adaptive Behavior Composite (ABC) domains. Independent samples t-tests, receiver operating characteristic (ROC) analyses, and cross-tabulation analyses were subsequently performed on the residual z-scores. When comparing standard scores without controlling for intelligence, the ASD group scored significantly lower than the other NDD group across all domains. However, comparisons of residual z-scores revealed that the group difference in the Communication domain was no longer statistically significant. The Socialization domain demonstrated the largest effect size (d=.991) and most clearly differentiated the two groups, with significant group differences also identified in Daily Living Skills and ABC. ROC analysis indicated that the area under the curve (AUC) for the Socialization residual z-score was .759, reflecting acceptable discriminative ability, and classification accuracy at the optimal cutoff point (z=.18) was 69.8%, the highest among all domains examined. These findings suggest that socialization deficits in preschoolers with ASD reflect characteristics that cannot be fully accounted for by intelligence level alone, and that the K-Vineland-II Socialization domain residual z-score, with intelligence controlled, may serve as a useful supplementary index for the differential diagnosis of ASD in early childhood.

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