執行功能測驗於注意力不足過動症臨床診斷之運用

研究背景：注意力不足過動症（Attention Deficit/Hyperactivity Disorder，簡稱ADHD）兒童除了展現注意力不足和過動衝動的臨床特徵外，過去國外學者也綜合許多歷年來的認知測驗及腦部相關等文獻，彙整出不同執行功能障礙的認知架構。因此，本研究試圖探索台灣ADHD兒童執行功能測驗的表現，檢驗執行功能測驗的ROC曲線（ROC curve）、命中率（hit rate）及決斷分數（decision scores），並進一步分析測驗與ADHD症狀的相關性，以及年齡、智力對測驗的預測程度。研究方法：本研究納入各53名6到12歲的ADHD及一般發展兒童，配對年齡、性別及FSIQ（Full Scale Intelligence Quotient，簡稱FSIQ）後，比較兩組控制干擾（interference control）的抑制能力、計畫（planning）、轉移（shifting）、語文（verbal working memory）及空間工作記憶（spatial working memory）等五項執行功能。研究結果：（一）測量計畫能力的連環圖系及轉移能力的路徑描繪測驗錯誤數在兩組並未達顯著差異。（二）在結構方程模型中，發現色字干擾測驗反應時間、路徑描繪測驗反應時間、數字序列測驗、空間記憶廣度測驗為同一構念；然而，測量抑制能力的色字干擾測驗錯誤數並非同一構念。（三）色字干擾、路徑描繪、數字序列以及空間記憶廣度測驗，命中率約70%。研究結論：本研究雖然發現ADHD兒童在控制干擾的抑制能力、轉移能力、語文工作記憶能力及空間工作記憶能力等四項執行功能顯著比一般發展兒童差，然而，此四項測驗對ADHD兒童命中率約70%。

關鍵字

ADHD ；執行功能； ROC ；命中率

並列摘要

Background: Attention Deficit/Hyperactivity Disorder (ADHD) children in addition to attention deficit and hyperactivity impulsivity, foreign scholars in the past have combined many cognitive tests and brain related literatures over the years to cognitive structures that different executive dysfunctions. Therefore, this study attempts to explore the performance of executive function (EF) tests in children with ADHD in Taiwan, to EF tests the ROC curve, hit rate and decision scores, and to analyze the correlation between tests and symptoms of ADHD, as well as the age and IQ predictions of the test. Methods: This study included 53 children aged 6 to 12 years with ADHD and general group. After pairing age, gender, and FSIQ (Full Scale Intelligence Quotient, FSIQ), the two groups were compared with the interference control, planning, shifting, verbal, and spatial working memory (WM). Results: (1) The Picture Arrangement (PA) of the measure planning ability and Trail Making Test (TMT) errors of the shifting did not significant difference between the two groups. (2) In the structural equation model, the Color-word interference test (CWIT) reaction time, TMT reaction time, the Letter number sequencing (LNS), and the Spatial span (SS) test are found to be the same construct; however, the CWIT errors measuring the interference control is not the same construct. (3) CWITRT, TMTRT, LNS and SS, the hit rate is about 70%. Conclusions: Although this study found that ADHD children had poorer performance in interference control, shifting, verbal and visual-spatial WM than children with general development, these four tests have an hit rate for children with ADHD 70%.