ADHD兒童之專心與過動衝動表現與心跳變異率之相關研究

The relationship of heart rate variability and measures attention and hyperactivity/impulse control in children with ADHD

謝依帆(Yi-Fan Hsieh)

指導教授 ： 李佩秦 ； 陳錦宏

中山醫學大學/醫學科技學院/醫學檢驗暨生物技術學系碩士班/碩士(2014年)

https://doi.org/10.6834/CSMU.2014.00127

摘要

研究目的：本研究之主要目的為探討ADHD複合型兒童及不注意型兒童在高登診斷系統(Gordon Diagnostic System)各任務(延遲等待任務、警覺任務與分心任務) 表現的差異、HRV的差異及任務執行表現與其HRV的相關性。
研究方法及資料：樣本來源是經由中山醫院兒童心智科門診確定ADHD之診斷後，由研究者事前邀請受試者監護人參與研究，此研究已通過中山醫學大學附設醫院臨床試驗委員會審查，經同意後由受試者及其照顧者來院受測，測驗地點為中山醫學大學之實驗室；進行的測驗包含GDS、HRV及WISC-IV測驗，每位受試者約需受測110~140分鐘。。本研究經資料蒐集完成之後，以敘述性分析分析呈現，分析方法以SPSS for windows 17.0版套裝軟體進行「獨立樣本T檢定」及「皮爾森相關係數檢定」。
研究結果：
分析受試者在執行GDS各任務時整體心率變異數的差異，顯示兒童在心律變異數據顯著的差異。而分析高登診斷系統的表現與HRV的相關性，亦發現兩者之間有顯著輕度至中度的相關性。
結論與建議：
不同亞型之ADHD兒童，在執行相同任務時的生理狀態有顯著的差異，顯示其執行任務的努力程度及放鬆狀態會受到任務難度及目標物的具體程度而影響，而生理上的努力可以降低執行任務的錯誤率。本研究是以心律變異數的VLF、LF、HF來探討ADHD兒童之專心與過動衝動表現間之差異及相關性，過去研究中多以LF來探討努力程度，但少以VLF及HF來探討VLF及HF與過動衝動及放鬆程度的關係。本研究以LF探討ADHD兒童的努力程度時，本研究與過去研究結果一致，不同亞型在執行任務時的努力程度有顯著差異。而本研究以VLF及HF來探討不同亞型兒童施測時的生理狀態，研究發現兩組兒童在執行GDS的多項任務表現中，除了LF外，在VLF及HF上其生理狀態亦有顯著差異，顯示未來研究可使用LF探討其努力程度外，亦可選擇使用VLF及HF來探討交感神經活性與副交感神經活性在執行任務或是其他活動時可能造成的影響。

關鍵字

ADHD ； 心率變異數 ； 高登診斷系統 ； 交感神經

並列摘要

Objective：The objective of this study was to investigate the ADHD- Combined and ADHD-Inattention children in Gordon Diagnostic System for each task (Standard Delay tasks, vigilance tasks and Distractibility Tests) differences in performance, the difference of HRV and task execution performance HRV to their relevance.
Methods and Materials：Sample sources confirm the diagnosis of ADHD children by Chung Shan Medical University Hospital, by the investigator prior to invite participation in research subjects guardian, this study has been reviewed by the Chung Shan Medical University Hospital Clinical institutional review board, After approval by the subjects and their caregivers to the hospital under test, test location for the laboratory, Chung Shan Medical University; tests conducted included GDS, HRV and WISC-IV tests, each subject about subjects from 110 to 140 minutes. After the data collection, valid samples were processed and analyzed by independent samples T test and Pearson correlation coefficient test by SPSS for windows 17.0.
Results：
Analysis of the subjects in the implementation of each task GDS of differences in heart rate variability, the data suggest that children significant differences in heart rate variability. The analysis of the performance of Gordon diagnostic system and the relevance of HRV also found to have mild to moderate significant correlation between the two.
Conclusion and Suggestion：Different subtypes of ADHD children, there were significant differences in the physiological state to perform the same task, showing the extent of its efforts to perform the task and the task will be difficult relaxed state and the presence of clear targets and influence, physical effort can reduce the error rate to perform tasks. This study is based on the VLF, LF, HF of heart rate variability discussion to explore the differences between ADHD children INATTENTION and hyperactive impulsive children's performance and and relevance to investigate the LF efforts in past studies, but less to VLF and HF to discussion VLF and HF relationship with hyperactive impulsive and degree of relaxation. This study was to investigate the extent of the efforts LF children with ADHD, the study results are consistent with past research, there are significant differences between different subtypes of the level of effort to perform tasks. In This study, VLF and HF to explore the physiological status of children of different subtypes of measurement time, the study found that both groups of children in a tasks in the performance of GDS, in addition to LF, the VLF and HF are also significant differences in the physiological state display can be used for future research to explore outside their effort LF, VLF and HF may also choose to use to investigate the effect of sympathetic activity and parasympathetic activity influence in the performance of tasks or other activities.

並列關鍵字

ADHD ； heart rate variability ； Gordon diagnostic system ； sympathetic

參考文獻

Allen, M. T., Matthews, K. A., & Kenyon, K. L. (2000). The relationships of resting baroreflex sensitivity, heart rate variability and measures of impulse control in children and adolescents. International Journal of Psychophysiology, 37, 185-194.

American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders. 4th text-revision edition. Washington, DC: American Psychiatric Association.

Barkley RA. (1991). The ecological validity of laboratory and analogue assessment methods of ADHD symptoms. Journal of Abnormal Child Psychology, 19, 149–178.

Beauchaine, T. P., Katkin, E. S., Strassberg, Z., & Snarr, J. (2001). Disinhibitory psychopathology in male adolescents: Discriminanting conduct disorder from attention-deficit/hyperactivity disorder through concurrent assessment of multiple autonomic states. Journal of Abnormal Psychology, 110, 610-624.

Bilchick, K. C., & Berger, R. D. (2006). Heart rate variability. Journal of cardiovascular electrophysiology, 17, 691-694.