- 學位論文
自我知覺訓練對疑似注意力缺失過動兒童社交技巧之成效探討
Efficacy of Self-Perception Training on Social Skills in Children with Attention Deficit Hyperactivity Disorder Characteristics
摘要
研究背景與目的：注意力缺失過動疾患是兒童期常見的精神疾患，多數注意力缺失過動疾患兒童會面臨社交上的困難。最近研究發現注意力缺失過動疾患兒童有正向錯覺偏誤的現象，此現象會影響兒童面對治療的動機和學習的效果。本研究目的在於檢視自我知覺訓練團體是否能有效降低疑似注意力缺失過動疾患兒童在社交領域正向錯覺偏誤的現象，並促進兒童在社交技巧訓練中的訓練動機，本研究加入同儕互動課程與社交技巧訓練結合之控制組進行比較與討論，探討兩組在介入上的不同效果，以及臨床上的應用與效益。 研究方法：參與者為國民小學中年級（年齡在8歲6個月到10歲9個月之間）兒童，透過教師評量問題行為篩選量表國小版，以高於切截分數之疑似注意力缺失過動疾患兒童為研究對象共13位，隨機分派至自我知覺訓練加社交技巧訓練組（6位）以及同儕互動課程加社交技巧訓練組（7位），以自我知覺社會接納向度效標差距分數、兒童社交技巧量表（教師版）以及兒童行為檢核表DSM量尺注意力過動問題為評估工具，使用重複量數變異數分析來探討組別差異，利用相依樣本T檢定分別分析兩組進步幅度。另外，分別計算各組在各量表之效果量（Cohen's d）以檢驗結果實際顯著性之程度。 研究結果：研究結果發現，兩組兒童皆隨時間顯著降低自我知覺社會接納向度效標差距分數，同時能有效提升兒童社交技巧量表（教師版）中肯定能力以及量表總分，降低注意力過動問題之分數。然而，進一步分析各組效果，發現自我知覺訓練加社交技巧訓練組在降低自我知覺社會接納向度效標差距分數、提升社交技巧皆為大效果量，在注意力過動問題儘管未達顯著差異，但仍為中等程度效果量。而同儕互動課程加社交技巧訓練組在兒童行為檢核表中注意力過動問題改善程度達顯著，且為大效果量。 討論：本研究認為兩組兒童皆能有效降低社交領域正向錯覺偏誤的現象，不能排除治療同盟關係的影響，本研究支持自我保護假說在正向錯覺偏誤中扮演的角色，而降低正向錯覺偏誤能有效促進兒童在社交技巧訓練中的效果。然而，針對注意力缺失過動疾患兒童的核心問題，包括注意力不足、過動與衝動行為，可使用認知行為基礎的訓練模式來改善。綜合上述，本研究認為注意力缺失過動疾患兒童出現的社交問題是複雜的，需考量兒童正向錯覺偏誤在其中的效應，並建議臨床工作需重視兒童正向錯覺偏誤對於介入效果的影響。
並列摘要
Purpose: Attention Deficit/ Hyperactivity Disorder (ADHD) is a common clinical children’s disorder, and almost more than half of children with ADHD have social difficulties. Recently, researchers have found out that children with ADHD exhibit positive illusory bias of their competence, and a child with ADHD with positive illusory bias about one’s competence at the beginning of the intervention results in poorer response to the intervention. The purpose of the current study is to investigate the efficacy of self-perception training on reducing the positive illusory bias of the social domain of children with ADHD characteristics and on enhancing the motivation of social skills training. The current study adds an active control group to discuss the difference between self-perception training and active control group to the efficacy. Method: 13 boys with ADHD characteristics (age 8.5-10.75) were randomly assigned to self-perception training plus social skills training (6 boys) or to an active control group plus social skills training (7 boys). The Self-Perception Profile for Children (SPPC) was used to measure positive illusory bias, and the Social Acceptance subscale was used. The current study compared the boys’ self-report on the SPPC against the teacher’s report on the parallel teacher version. The Social Skills Rating System (SSRS) was used to measure social skills of children. The Attention-Deficit/Hyperactivity Scale of the Children Behavior Checklist (CBCL) was used to measure the attention deficit hyperactivity problem. Results: Our result indicated that children with both self-perception training or active control group could reduce the discrepancy of the Social Acceptance subscale between the boys’ self-report and the teacher’ s report. Both groups could improve children's assertiveness and the total score of SSRS of teachers' report and reduce the Attention-Deficit/ Hyperactivity Scale of CBCL. Moreover, children with self-perception training plus social skills training reduce the discrepancy of the Social Acceptance subscale and improve assertiveness, cooperation and the total score of SSRS on large effect size. Children with active control plus social skills training reduce Attention-Deficit/ Hyperactivity Scale of CBCL on large effect size. Discussion: Our result indicated that children with both groups could reduce the positive illusory bias of the social domain and enhance the efficacy of social skills training. We conclude that self-protective hypothesis plays a role on positive illusory bias. Although the attention deficit hyperactivity problem of children with self-perception training plus social skills training did not statistically improve the difference of pre- and post- tests, it still had medium effect size. In conclusion, the current study believes the complication of social difficulties with children with ADHD, and we must give great care upon the impact of positive illusory bias.
參考文獻
延伸閱讀
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