運用眼球追蹤技術探討國小注意力不足過動症學童在篇章閱讀上的眼動表現及虛擬實境訓練前後之差異

Using Eye Tracking Technology to Explore Reading Eye Movement Performance and the Effect of Virtual Reality Training in Elementary School Children with ADHD

古曜瑋(Yao-Wei Gu)

指導教授 ： 郭蕙瑛

共同指導教授 ： 蔡政道(Jeng-Dau Tsai)

中山醫學大學/醫學科技學院/視光學系/碩士(2022年)

https://doi.org/10.6834/csmu202200112

摘要

目的：本研究使用眼動追蹤技術 (Eye tracking technology) 探討注意力不足過動症 （Attention deficit/hyperactivity disorder，以下簡稱 ADHD）與同年級學童於閱讀不同讀本情境下（讀答任務、直橫格式與短長篇幅）的眼球運動表現，本研究以篇章閱讀時的眼動指標呈現閱讀時的眼動表現。並且本研究嘗試使用虛擬實境（以下簡稱 VR）遊戲進行訓練，探討篇章閱讀的眼動指標於訓練前後的差異。
方法：本研究納入 60 位國小學童，實驗組為 30 位經由兒科醫師診斷患有 ADHD 之學童，對照組為 30 位年級及性別與實驗組相匹配之學童。兩組參與者皆於研究第一階段通過問卷量表及篩選測驗，包含：家長版兒童注意力量表 (SNAP-IV)、修訂畢保德圖畫詞彙 (PPVT-R) 以及發育性眼動 (DEM) 測驗。第二階段為閱讀眼動測試，使用 EyeLink1000 桌上型眼動儀，依據受測學童年級給予符合該年齡層理解能力之篇章結構讀本（採用教育部編訂國語文補充教材），每位參與者需完成文本閱讀（共 4 篇），再進行閱讀測驗（共 5 題），並紀錄閱讀與答題過程中之眼動數據。第三階段為 VR 訓練，有 20 位 ADHD 組學童參與為期三個月的 VR 訓練，並在訓練後再次進行閱讀眼動測試以比較訓練前後之差異。本研究之數據分析使用 SPSS 統計軟體，統計方法採用獨立樣本 t 檢定及卡方檢定比較 ADHD 組與對照組的人口統計學特徵與篩選檢測。另外使用四因子混合變異數分析 2（組別）× 2（讀答任務）× 2（直橫格式）× 2（短長篇幅）比較兩組參與者於不同閱讀情境下之眼動指標差異。ADHD 組的訓練表現使用成對樣本 t 檢定，評估訓練前後於不同讀本之閱讀眼動指標的變化。
結果：兩組研究參與者皆通過智商、基礎語言詞彙能力及基本視覺能力之篩選檢測
，於年級 (p = 0.787)、性別 (p = 0.754)、年齡 (p = 0.448) 皆無顯著差異。在篇章閱讀的眼動指標發現，ADHD 組的總閱讀時間 (p = 0.001) 與凝視持續時間 (p = 0.008) 明顯較對照組學童長；且凝視 (p = 0.005) 與回視次數 (p = 0.001) 也明顯較對照組多。ADHD 組經過 VR 訓練後，於不同閱讀情境下的總閱讀時間 (p = 0.017)、凝視持續時間 (p = 0.004) 的眼動指標顯著比訓練前短；凝視 (p = 0.010) 與回視次數 (p = 0.002) 與訓練前相比也顯著減少。
結論：透過 ADHD 組與對照組學童在靜默閱讀過程中的眼動指標，顯示 ADHD 組的眼動指標在閱讀歷程時，大多傾向有較差的閱讀眼動表現（包含凝視與回視次數較多、凝視持續時間較長），且花費更多時間完成閱讀任務。而藉由 VR 訓練 ADHD 的注意力等認知能力，可能有助提升其閱讀眼動表現。期望未來有更多研究得以探討 ADHD 學童於認知能力、閱讀表現，與眼動歷程之關係。

關鍵字

注意力不足過動症 ； 眼球追蹤 ； 讀本閱讀 ； 虛擬實境訓練

並列摘要

Purpose: Using eye tracking technology to explore the eye movement of attention deficit hyperactivity disorder (ADHD) children and their controls under various reading conditions (reading task, text directionality and short/long length). In this study, the eye-movement performance was evaluated using an eye-tracker and a variety of eye-movement measureswere recorded during reading. Furthermore, a virtual reality (VR) game was applied for cognitive training and changes in reading eye movement measures were compared before and after the VR training.
Methods: The study participants included 60 elementary school children, 30 of whom were diagnosed with ADHD by the pediatrician of CSMU Hospital and 30 of whom were normal subjects with matched grade and gender. Both groups were evaluated using Peabody Picture Vocabulary Test-Revised (PPVT-R), the Swanson, Nolan, and Pelham, Version IV (SNAP-IV), and the Developmental Eye Movement Test (DEM) at the first phase. For the second phase, their reading eye movement was assessed by an eye tracker (EyeLink 1000). Subjects were given text according to their grade level. Every participant completed four reading tasks, followed by a five-question reading test, and their eye movement trajectory was recorded during both the reading text and reading exam. Finally, in the third phase, 20 ADHD children volunteered to participate in a three-month virtual reality training and an additional eye traking testing was applied after the training to compare the difference in reading eye movement between the pre- and post-training period. Data were analyzed using independent sample t-tests and chi-square tests with SPSS software to compare the results of demographic characteristics and screening testing between the two groups in the first phase. A four-factor mixed variance analysis of 2 (Group) × 2 (reading task or exam) × 2 (vertical or horizontal format) × 2 (short or long length) was used to compare whether there were significant differences between the two groups of eye movement measures under various reading conditions. The differences between pre- and post-training measures of the ADHD group were assessed using paired sample t-tests.
Results: The results showed that ADHD group had significantly longer total reading time (p = 0.001), increased fixation duration (p = 0.008), more fixation counts (p = 0.005), and regression counts (p = 0.001) after examining their IQ, verbal vocabulary, and visual function. The grade (p = 0.787), gender (p = 0.754), and age (p = 0.448) of the two groups were matched, and no significant difference was found between groups. After three-month virtual reality training, it was shown that the ADHD group had a shorter total reading time (p = 0.017), shorter fixation duration (p = 0.004), and less fixation (p = 0.010
) and regression counts (p = 0.002).
Conclusion: Using eye tracking technology to study eye movement measures of the ADHD group and the control group during silent reading, it was shown that the ADHD group tended to have poorer eye movement measures in reading conditions (longer fixation durations, more fixation and regression counts) and took more time to complete the reading tasks. In addition, training cognitive abilities such as attention in ADHD through VR games may help improve their eye movement measures during reading. The relationship between cognitive ability, reading measures, and eye movement experiences in children with ADHD still require more investigations in future research.

並列關鍵字

attention deficit hyperactivity disorder ； eye tracking ； text reading ； virtual reality training

參考文獻

1. Widiger TA, Costa PT, Association AP. Personality disorders and the five-factor model of personality. JSTOR; 2013.

2. Gizer IR, Ficks C, Waldman ID. Candidate gene studies of ADHD: a meta-analytic review. Human genetics. 2009;126(1):51-90.

3. Ramoz N, Boni C, Downing AM, et al. A haplotype of the norepinephrine transporter (Net) gene Slc6a2 is associated with clinical response to atomoxetine in attention-deficit hyperactivity disorder (ADHD). Neuropsychopharmacology. 2009;34(9):2135-2142.

4. English BA, Hahn MK, Gizer IR, et al. Choline transporter gene variation is associated with attention-deficit hyperactivity disorder. Journal of neurodevelopmental disorders. 2009;1(4):252-263.

5. Giedd JN, Raznahan A, Alexander-Bloch A, Schmitt E, Gogtay N, Rapoport JL. Child psychiatry branch of the National Institute of Mental Health longitudinal structural magnetic resonance imaging study of human brain development. Neuropsychopharmacology. 2015;40(1):43-49.