全面性發展遲緩兒童之母親互動行為、精熟動機和發展能力之雙向關係

Bidirectional Relations among Maternal Interactive Behavior, Mastery Motivation, and Developmental Ability in Children with Global Developmental Delay

汪佩蓉(Pei-Jung Wang)

指導教授 ： 廖華芳

共同指導教授 ： 陳麗秋(Li-Chiou Chen)

國立臺灣大學/醫學院/物理治療學研究所/博士(2016年)

https://doi.org/10.6342/NTU201700561

摘要

母親行為與兒童行為相互影響。母親互動行為會影響發展遲緩兒童的功能，包含認知、動作發展能力及精熟動機等，同時兒童行為也會影響母親行為。過去研究大多單方向地探討母親互動行為對遲緩兒童行為之影響，但對於母親互動行為、兒童能力及兒童動機之間在發展過程中如何相互作用，目前尚不清楚。因此，本研究目的為要探究全面性發展遲緩兒童之母親互動行為與兒童發展能力及精熟動機之間的關係與交互影響，包括：(1)母親行為和兒童認知、精細動作能力的雙向關係; (2) 母親行為和精熟動機的雙向關係; (3)兒童精熟動機和認知、精細動作能力的雙向關係；(4)兒童精熟動機是否為早期母親行為預測後期兒童認知或精動作能力之中介因子。方法：本計畫為一長期追蹤研究，從大台北地區徵召56組24-42個月大之全面性發展遲緩兒童及其母親，評估母親行為、兒童發展能力、及兒童精熟動機，並於6個月後再追蹤一次。測量內容包括:用「兒童教導量表」(Nursing Child Assessment Teaching Scale, NCATS)評估母親互動行為，以「嬰幼兒綜合發展測驗」(Comprehensive Developmental Inventory for Infants and Toddlers, CDIIT)測量兒童認知與精細動作發展能力，以「個別化結構性精熟任務修正版」(Revised Individualized Structured Mastery Tasks, ISMT-R)測量兒童之精熟動機。為避免評估時間過於冗長，所有評估於家訪和研究室分二次完成。統計分析：首先用相關分析結果以提出可能的假設模型，其次用路徑分析檢驗全面性發展遲緩兒童之母親行為和兒童發展能力或精熟動機之雙向模型，及兒童精熟動機在此關係之中介模型。結果：早期母親互動行為顯著且正向的預測6個月後兒童之認知和精細動作能力；但兒童早期認知和精細動作能力無法顯著的預測6個月後母親之互動行為。路徑分析顯示，兒童精熟動機和母親行為及其認知或精細動作能力之關係皆為顯著的雙向模型；兒童精熟動機為早期母親行為預測6個月後之兒童認知和精細動作發展能力之中介模型也驗證成功。結論：此研究發現早期母親互動行為可預測之後兒童認知及精細動作能力和精熟動機；兒童早期精熟動機能預測之後兒童認知/精細動作能力與母親行為，但兒童早期發展能力無法預測之後的母親行為；兒童精熟動機和認知或精細動作發展能力的互動是雙向關係。本研究結果證實母親行為和兒童精熟動機會交互影響，此結果支持交互動態發展模式。更重要的是精熟動機為早期母親行為預測後期兒童發展能力之中介因子。換言之，早期母親行為先影響同時的兒童精熟動機後，再影響日後兒童認知和精細動作發展能力。臨床應用：臨床人員必須重視母親互動行為品質和兒童動機，因前兩者皆可促進兒童日後發展能力。

關鍵字

母親互動行為 ； 精熟動機 ； 發展遲緩 ； 發展能力 ； 兒童

並列摘要

Maternal and child behaviors are mutually related. Maternal interactive behavior has important impacts on functioning of children with developmental delays, including cognitive and motor abilities as well as mastery motivation. On the other hand, children’s functioning influences maternal behaviors as well. Previous research mostly focused on the uni-directional relations of maternal behavior to developmental ability of children with developmental delays. It was unclear how the interplay between maternal behavior and children’s abilities and motivation evolves during the early years for children with developmental delays. Therefore, the purpose of this research was to longitudinally investigate: (1) the bidirectional relations between maternal behaviors and children’s developmental ability (cognitive and fine motor); (2) the bidirectional relations between maternal behaviors and children’s mastery motivation; (3) the bidirectional relations between children’s mastery motivation and children’s developmental ability (cognitive and fine motor); (4) whether children’s mastery motivation mediated the relationship between early maternal behavior and children’s later cognitive or fine motor ability in children with global developmental delay (GDD). Methods: Fifty-six mother-child dyads of 24-42 month-old toddlers with GDD were recruited from the greater Taipei area. All participating dyads were assessed at study entry and at a 6-month follow-up for maternal behavior, child developmental ability, and mastery motivation. Maternal behaviors were assessed using the Nursing Child Assessment Teaching Scale (NCATS). Children were tested using the Comprehensive Developmental Inventory for Infants and Toddlers (CDIIT) for cognitive and fine motor ability and the revised individualized structured mastery tasks (ISMT-R) for mastery motivation. To prevent testing fatigue, all assessments were distributed in two testing sessions: a home visit or laboratory to assess the CDIIT and obtain basic information from each participant and a laboratory visit to conduct the NCATS and ISMT-R. Statistical analysis: In order to explore the possible bidirectional relationships among maternal behavior and developmental abilities as well as mastery motivation, a Pearson correlation matrix for the maternal and child indicator variables at the same time and at both times was produced. Based on the results of the correlation matrix, possible hypothetical models between maternal behavior and child developmental ability as well as mastery motivation were proposed and examined by path analyses. The mediational effect of child mastery motivation was also examined by path analysis. Results: We found that maternal behavior significantly and positively predicted children’s later cognitive ability and fine motor ability, but children’s cognitive and fine motor ability did not significantly predict later maternal behavior. The bidirectional models between maternal behavior and mastery motivation, and between mastery motivation and developmental abilities (cognitive or fine motor) were validated. The models of mediational effect of child mastery motivation between early maternal behaviors and later cognitive or fine motor ability were validated. Conclusions: The study found that early maternal behavior predicted later cognitive and fine motor abilities as well as mastery motivation. Early children’s mastery motivation predicted later maternal behavior, but children’s early ability did not predict later maternal behavior. We did find bidirectional relationships between early mastery motivation and later cognitive as well as fine motor abilities. The bidirectional relationship of maternal behavior and mastery motivation in this study supported the Transactional model of development. The most important result was that mastery motivation mediated the relationship between early maternal behavior and later cognitive and fine motor ability in children with GDD. In other words, early maternal behavior was associated with mastery motivation concurrently and then influenced later cognitive as well as fine motor ability. Clinical implications: It is necessary for clinicians to focus on children’s mastery motivation and quality of maternal interactive behavior because both of them facilitate children’s future developmental abilities.

並列關鍵字

maternal interactive behavior ； mastery motivation ； developmental delay ； developmental ability ； children

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