- 學位論文
發展協調障礙兒童在家中與學校的功能表現
Functional Performance of Children with Developmental Coordination Disorder at Home and School
摘要
背景與目的：發展協調障礙(developmental coordination disorder, 簡稱DCD)兒童常經驗到以動作為主活動的限制，以致負向地影響了兒童參與家中與學校的日常生活活動。促使DCD兒童有良好的職能表現是臨床人員與研究者的重點，但目前對於探討DCD兒童在家中與學校的日常生活功能表現的文獻不足，且多以與家長訪談的質性研究做討論。因此，本研究的主要目的是要有系統且全面性地探討不同嚴重程度的DCD兒童在家中與學校的功能表現。 方法：研究對象來自於大台北地區的8所小學。以兩個步驟的方法取樣，共有23名診斷為DCD (包含11名男童與12名女童)，45名診斷為疑似DCD (包含28名男童與17名女童)，另63名為正常對照組兒童(包含39名男童與24名女童)。樣本的年齡範圍為6歲3個月至9歲10個月。給予家長填寫「文蘭適應行為量表」中之動作相關分量表(包含個人生活技巧、粗動作、精細動作)，並給予導師填寫「學校日常生活功能評量」第三部份的九項與動作相關的分量表。 結果：多變項共變數分析結果顯示在「文蘭適應行為量表」與「學校日常生活功能評量」皆有組間的差異。卡方檢定的結果顯示，DCD組與疑似DCD組在「文蘭適應行為量表」的三個分量表的適應程度上，皆與對照組有顯著的差異；DCD組與疑似DCD組則在粗動作與精細動作分量表上有顯著差異，而在個人生活技巧分量表則無達到顯著。比較三組兒童在「學校日常生活功能評量」的九個分量表中，分數低於切點分數人數比例的差異，結果顯示DCD組與對照組在九個分量表皆達顯著；疑似DCD組與對照組在七個分量表達顯著；而DCD組與疑似DCD組僅在兩個分量表達到顯著。 結論：本研究的結果顯示DCD廣泛地影響了兒童在家中與學校的日常生活功能表現，且研究結果顯示所有動作發展問題的兒童，不管嚴重程度為何，都有較高的機率會呈現日常生活功能表現的問題。
並列摘要
Background and Purpose: Children with developmental coordination disorder (DCD) experience considerable restrictions in motor-based activity and it negatively influences the participation in daily living activities at home and school. Enabling the functional performance of children is the major goal of the clinicians and researchers who work with children presenting with DCD. Little research has been done in this area and most studies are qualitative studies in nature using interview with parents. Thus, the purpose of this study is to systematically investigate the functional performance of children with DCD in daily living activities with different degrees of motor coordination impairment in both home and school contexts. Methods: Participants were recruited from eight public elementary schools of the larger Taipei area. Based on a two-step sampling procedure, 23 children were identified with DCD (11 males and 12 females) and 45 as suspected DCD (28 males and 17 females). Sixty-three children without motor problems served as controls participated in this study (39males and 24 females). Participants were aged between 6 years 3 months and 9 years 10 months. Parents were asked to fill out the personal subscale of daily living skills and subscales of motor skill domains of the Vineland Adaptive Behavior Scales (VABS), and classroom teachers were asked to fill out 9 subscales of the physical task session of Part III of the School Functional Assessment (SFA). Results: MANCOVA revealed significant group differences on daily living skills as measured by the VABS and the SFA (ps <.05). Chi-square analyses revealed significant differences on the proportion of children in inadequate adaptive level of the personal living skills, gross motor and fine motor subscales of the VABS between the DCD, suspected DCD and control groups. Significant group differences were noted on the VABS gross motor and fine motor subscales between children with DCD and suspected for DCD. As to functional performance at school, results indicated significant differences in the proportion of children who scored lower than the cut-off score on all nine SFA subscales between the DCD and the control groups while significant group differences on seven out of nine SFA subscales was noted between the suspected DCD and the control groups . For DCD and suspected DCD groups, significant differences were noted on only two out of nine SFA subscales. Conclusion: The study findings demonstrate the pervasive impact of DCD on children’s functional performance at both home and school in daily occupations. The results also indicate that all children with developmental movement problems, no matter what the degree or severity, are at risk for problems in school and daily life function.