執行功能、注意力缺失過動症狀與心智理論能力探討－以大學生為對象

Exploration of executive function, attention deficit hyperactivity symptoms and theory of mind in college students

邱瀞姿(Jing-Zih Chiu) ； 葉在庭(Zai-Ting Yeh)

《特殊教育研究學刊》 47卷1期 (2022/03) Pp. 61-91

https://doi.org/10.6172/BSE.202203_47(1).0003

摘要

注意力缺失／過動症（ADHD）雖為兒童期診斷，但許多症狀仍可能延續到成年期，並使個體的人際相處產生困難，許多學者認為執行功能缺損引發是引發注意力缺失、過動與衝動症狀的認知脆弱因素，此外，執行功能也可以導致個體社交技巧不足，容易被同儕拒絕之原因，心智理論能力不佳，會使個體在人際互動中較難推論他人的想法、情緒與動機等，而影響其人際關係，最終導致ADHD個體的社會與職業困境。有關ADHD執行功能缺損假說，過去研究大部分為兒童及青少年，但是執行功能缺損會持續至成年期，目前針對執行功能與成年後ADHD症狀的關係，缺乏實證資料。因此，本研究的目的為檢驗執行功能是否能預測其大學生ADHD症狀，執行功能是否能預測其心智理論能力以及執行功能對心智理論的影響是否受到ADHD症狀所中介。本研究共招募35位ADHD症狀大學生與35位正常大學生，兩組在人口學變項一致，並控制智力分數，進行執行功能與心智理論能力的評估。結果發現：控制智力分數後，執行功能可以解釋ADHD症狀最高至62%的變異量，而且智力分數對ADHD症狀並無影響；執行功能可以解釋大學生情感心智理論最高至17%的變異量，智力分數則有12%的影響；進一步的中介模式分析結果顯示，大學生執行功能透過ADHD症狀中的缺乏注意力可以預測情感心智理論的能力表現。建議未來對於成年前期ADHD族群，不論在教育領域，輔導介入模式或心理治療，強化執行功能將有效改善其症狀與人際關係。

關鍵字

大學生 ； 心智理論 ； 注意力缺失／過動 ； 執行功能

並列摘要

Rationale/Purpose: Attention Deficit Hyperactivity Disorder (ADHD) is a common psychiatric disorder characterized by cross-situational inattention, hyperactivity, and impulsivity. Although ADHD is often diagnosed in childhood, many symptoms may continue into adulthood. These symptoms may cause the patients to have difficulty in social interactions or in their academic or professional lives. Executive function is a top-down process involving inhibitory control, working memory, and cognitive flexibility. These core abilities are the basis for higher-order executive functions such as reasoning, problem solving, and planning. The core executive functions are related to ADHD patients' inability to persist in their behavior and to inhibit their potential responses, and such deficits eventually affect their working memory and self-regulation. Thus, research indicates that executive function deficits are the cognitive vulnerability factors that cause the symptoms of insufficient attention, hyperactivity, and impulsivity. When these executive function deficits continue into adulthood, they can lead to further impairment throughout ADHD patients' lives. In addition, executive function deficits can also lead to insufficient social skills and rejection by peers because of the patients' difficulties in recognizing social information. Executive function deficits are related to social cognition, the core of which is theory of mind (ToM). Poor ToM ability makes it difficult for individuals to infer other people's thoughts, feelings, and motivations in interpersonal interactions, and such difficulties will in turn affect their interpersonal relationships and ultimately lead to social and professional dysfunction in individuals with ADHD. From the developmental perspective, some researchers also believe that ToM is an ability that can only be acquired after executive function matures. Though some researchers have begun to explore the relationships among ADHD symptoms, executive function and ToM, most studies to date have focused on children and adolescents, despite executive function deficit often continuing into adulthood. That is, there is still a lack of empirical research confirming the relationship between executive function and ADHD symptoms in adulthood. Therefore, the purpose of this study was to examine whether the executive function of college students can predict symptoms of ADHD and ToM ability, and also whether the influence of executive function on ToM is mediated by ADHD symptoms. Moreover, in the past, measures of executive function have also been limited to standardized tests. To improve the ecological validity of this study, self-reported inventories were also included. Methods: In this study, 35 college students with ADHD traits and 35 neurotypical college students in northern Taiwan were recruited through the Internet and grouped by their scores on the Traditional Chinese College ADHD Response Evaluation Student Response Inventory. The exclusion criterion was any diagnosis of a psychiatric disorder other than ADHD. The two groups had the same demographic variables, including gender, age and parents' education levels. Their intelligence scores were controlled for, and their executive function and ToM abilities were evaluated. The measures adopted in this study included a ToM assessment and a variety of executive function tasks and self-reported inventories, such as Conners' Continuous Performance Task (CPT), the Digit Span Test, the Trail Making Task-B, the Adult Executive Functioning Inventory (ADEXI), and the Chinese Executive Function Index for College Students (CEFI-C). As a control variable, intelligence scores were obtained by using the WAIS-III short form. After the assessments were conducted, descriptive statistics, t tests, hierarchical regression, and analysis of the mediation model were performed in SPSS 20.0 software. Results/Findings: The results showed that college students with ADHD traits performed worse than their neurotypical peers on the commission scores in all dimensions of the CPT and self-reported executive function inventories. Affective, verbal, and nonverbal ToM were significantly impaired in college students with ADHD traits as compared with the normal controls. Significant correlations were found among ADHD traits, executive function deficit, and ToM. With intelligence scores controlled for, executive function explained up to 62% of the variance of ADHD traits, while intelligence scores had no effect. Executive function explained up to 17% of the variance in the affective ToM of college students, and intelligence scores had an impact of 12%. However, cognitive ToM was not explained by executive function. The ADHD traits explained up to 32% of the variance in ToM, and intelligence scores had an impact of 35%. Of the ADHD traits, only inattention explained the variance in ToM, so it was treated as a mediating variable in further analysis. The mediation model showed that the executive function of college students could predict their performance on affective ToM through lack of attention, an ADHD symptom. Lack of attention fully mediated the influence of working memory, organizational planning and impulse control on affective ToM. Conclusions/Implications: This study indicates that college students with ADHD traits perform considerably worse on executive function and have poor performance in ToM assessments. This difference indicates that, as compared with their neurotypical peers, college students with ADHD traits have difficulty inferring other people's thoughts, motivations, and emotions. In this study, it was found that the lack of attention of ADHD fully mediated the relationship between executive function and affective ToM, which is concerned with developing empathy in individuals and is the foundation of good social and interpersonal relationships in early adulthood, and this deficit led to frustration in interpersonal relations. It is recommended that in the future, for a pre-adult ADHD group in the field of education, in the mode of counseling intervention, or in psychotherapy interventions for executive function, training in inhibitory control, working memory and organizational planning has the potential to improve effectively their ADHD symptoms and ToM. Moreover, recent studies have proposed that joint attention, which requires the abilities of selective, alternating and divided attention, is a prerequisite of ToM. Future studies can further explore the relationship between different types of attention and ToM. Understanding of these relationships may be useful in the development of more specific social training for individuals with ADHD to improve their interpersonal relationships. Such interventions and training may help them to fit in with their peers and to be accepted or understood by their peers.

並列關鍵字

attention/deficit hyperactivity disorder ； executive function ； theory of mind

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