- 學位論文
發展協調障礙兒童之注意力、學習與心理社會調適問題
Attention, Learning and Psychosocial Adjustment Problems in Children with Developmental Coordination Disorder
摘要
背景與目的：許多被診斷為動作協調障礙兒童 (Developmental Coordination Disorder，DCD) 常合併有注意力、學習及心理社會調適的問題。過去有許多探討DCD兒童的相關問題，但這些研究在選取研究個案時，通常只使用單一評估工具或非標準化測驗（老師或醫生轉介）來診斷DCD，無法篩選出不同亞型的DCD兒童。然而，先前使用超過二種評估工具來診斷DCD之研究多侷限於臨床樣本。因此，本研究的目的是以兩步驟選取法，探討社區樣本中DCD和疑似DCD兒童的注意力、學習問題及心理社會調適問題，以及不同動作障礙程度兒童在上述的表現。 方法：第一步驟以發展協調障礙問卷-中文版 (Developmental Coordination Disorder Questionnaire-Chinese version, DCDQ-C) 篩選出因動作問題而致日常生活功能受影響之兒童，第二步驟使用兩個標準化動作測驗，分別是兒童動作評量組 (Movement Assessment Battery for Children, MABC) 與布朗尼動作能力測驗 (Bruininks-Oseretsky Test of Motor Proficiency, BOTMP) 鑑定DCD組、疑似DCD組以及正常組。由家長填寫兒童活動量表及兒童行為檢核表，並給予兒童施測基本讀寫字綜合測驗。 結果：結果顯示三組在兒童活動量表和兒童行為檢核表之注意力向度上有顯著差異。在學習方面，看字讀音與看字造詞上，三組有顯著差異；在看注音寫國字與聽寫上，三組均無顯著差異；在心理社會調適問題上，DCD與疑似DCD兒童均比正常組顯示更多的問題，除了身體上的抱怨這一項；但DCD組與疑似DCD組之間並無差異。 結論：本研究結果顯示這一群未被轉介到臨床的社區兒童，透過兩步驟的方法鑑定為DCD的兒童，與臨床個案一樣，在注意力、學習發展與心理社會調適上均有問題；而被我們鑑定為疑似DCD的兒童與臨床個案一樣，在注意力與心理社會調適上均有問題，而在基本閱讀及書寫技巧上是沒有困難的；在不同動作障礙的DCD中，在注意力、學習與心理社會調適問題上都有相同的影響。因此，針對社區兒童進行動作協調障礙的篩檢，以早期發現、早期介入，對於後續學習問題的預防是相當重要的。此外，本研究結果提醒臨床工作者或父母需注意這一群未被轉介的DCD兒童，不僅在學習上要留意，更要注意其行為與心理社會調適問題。
並列摘要
Background and Purpose: Many children diagnosed with developmental coordination disorder (DCD) show problems with attention, learning and psychosocial adjustment. Much literature investigated the attention, learning and psychosocial adjustment issues of children with DCD, but most of them identified children with DCD through either one motor test or doctors’/teachers’ referral and one motor test. Although few studies used more than two tests for identification, they might use the clinical samples rather than community samples. Thus, the purpose was to use two-step procedure to identify children in the community and investigate the problems in attention, learning and psychosocial adjustment of the children with different degrees of DCD. Methods: The first step was to screen children with motor impairments by the Developmental Coordination Disorder Questionnaire-Chinese version (DCDQ-C). The second step used two standardized movement tests, i.e., Movement Assessment Battery for Children (MABC) and Bruininks-Oseretsky Test of Motor Proficiency (BOTMP) to identify the children with motor impairments. The parents of these children completed the Child behavior checklist- Chinese version (CBCL-C) and the Activity Level Rating Scale (ALRS). The children of the three groups received assessment of the Basic Reading and Writing Test Battery (BRWTB) by the examiner. Results: Results revealed significant group differences on the Attention Problems subscale of the CBCL-C and the ALRS. Results revealed marginal and significant group effects on two subtests of the BRWTB, but no significant group effects on another subtests of the BRWTB. Children with motor impairments had more difficulties in psychosocial adjustment problems except the Somatic Complaints than the control group, but no significant differences existed on psychosocial adjustment problems between children with different severity of motor impairment. Conclusion: In summary, the results of the study indicated that the non-referred children who were identified by standardized motor tests as DCD were like referred children who were reported to be often associated with problems in attention, learning and psychosocial adjustment. The results also indicated that non-referred children who were identified as suspect for DCD were at risk for problems in attention and psychosocial adjustment, but had no difficulties in basic reading and writing skills. Furthermore, the findings of the present study indicated that DCD had similar impacts on attention, learning and psychosocial adjustment of children with different severity of motor impairments. Thus, it is suggested that parents and teachers be aware of the behavior and psychosocial problems of their non-referred children with DCD, in addition to learning problems.