神經回饋於治療台灣注意力缺失/過動症兒童之療效初探

Efficacy of neurofeedback treatment in Taiwanese children with attention deficit/hyperactivity disorder : a pilot study

李伊婷(I-Ting Li)

指導教授 ： 楊品珍

高雄醫學大學/人文社會科學院/心理學系碩士班/碩士(2016年)

摘要

目的：注意力缺失/過動症為最常見的兒童神經發展疾患。常見為持續性、與發展年齡不符以及跨情境的注意力不足、過動以及衝動抑制能力的缺損並影響患童們家庭互動、學業表現、人際關係以及生活適應等功能。目前臨床上針對注意力缺失/過動的治療以藥物治療為主，但考量家長對藥物副作用的擔憂影響藥物遵從性，以及約有34%的兒童對藥物反應不佳，其他替代性療法，如神經回饋在國外逐漸受到重視並有大量文獻支持其於治療ADHD患童之療效，然而在台灣則缺乏足夠實徵證據支持其結果。本研究的目的主要在探討神經回饋對改善台灣注意力缺失/過動兒童核心症狀的成效和神經心理以及電生理學之變化。
方法：本研究由南部醫學中心精神科專科醫師轉介診斷為注意力缺失/過動兒童為研究對象，其中13名為神經回饋組，另外13名為控制組(無法配合神經回饋療程者納入此組)。所有兒童均已服用藥物半年以上，但僅部分進步。此研究期間不停藥，也無劑量或藥物類型的變動。研究基準期以及8週後，所有受試者須完成注意力測驗，家長需填寫行為評估量表。神經回饋組受試者8週內共接受20次的神經回饋，訓練方案主要為降低前中線區Theta/Beta強度比值(TBR)，並教導受試者降低前中線區theta活動量。
結果：研究結果發現，神經回饋組受試者在接受神經回饋後，其表現相較於控制組於注意力測驗以及家長評估量表皆顯著改善。神經回饋組受試者平均TBR超過3:1。然而，腦波資料分析結果顯示神經胡饋組受試者在接受神經回饋後Theta波活動量與TBR未有顯著差異。
結論：本研究結果支持神經回饋於改善台灣ADHD患童之核心症狀以及提升神經心理注意力測驗表現為一有效附加(add-on)治療方案。

關鍵字

注意力缺失/過動症 ； 神經回饋 ； 注意力 ； 衝動/過動 ； 腦波 ； Cz ； theta波 ； theta/beta波強度比值

並列摘要

Objective: Attention-deficit hyperactivity disorder (ADHD) is the most common neuropsychiatric disorder in children. It is defined by persistent, developmentally inappropriate, cross-situational, impaired levels of inattention, impulsiveness and hyperactivity. Children with ADHD have problems in multiple domains, such as family conflict, poor academic performance, problems with peer interaction, and life adaptation function. Stimulant drugs treatment has been one of the major therapeutic options for children with ADHD. However, roughly 34% of children are medication non-responders, many others are partial responders and parents voice concern about potential medication side effects. One of the promising alternatives to drug therapy for ADHD is neurofeedback which is supported by western extensive peer-reviewed literature, including large-scale controlled clinical trials. However, there are limited empirical data of the effect of neurofeedback in Taiwanese population. The purpose of the present study is to examine the effects of neurofeedback on the primary core symptoms as well as on neuropsychological and electrophysiological measures in Taiwanese children with ADHD. .
Method：Twenty-six children (7-12 years) with DSM-5 diagnosed ADHD were invited to join this study conducted in a medical center of south Taiwan. Thirteen subjects joined the neurofeedback group and 13 subjects were allocated to the control group because the treatment time schedules were not suitable for their parents. All subjects received ongoing stimulant treatment for more than 6

months with clinical impression as partial responder. Medication was continued
and unaltered during the whole study period. For the baseline and 8-week follow up assessments, all children received attention test while their primary caregivers completed two behavior rating scales. Subjects in neurofeedback group received quantitative EEG (QEEG) measurements and 20 training sessions /8 weeks in total. The training paradigm targeted electroencephalogram (EEG) Theta/beta brain wave ratio (TBR). Children were taught to decrease the excess theta at fronto-central locations.
Result： Significant improvements were noted on attention test and parental rating scales for subjects received neurofeedback training as compared with the control group. The average TBR power ratio from the neurofeedback group exceeded 3. However, the QEEG spectral power showed no significant change on theta activity and TBR power ratio after the neurofeedback training.
Conclusion : The study supports effect of neurofeedback training as add-on treatment for improving the core symptoms of Subjects in neurofeedback group showed ADHD and enhancement of attention in neuropsychological test in Taiwanese children with ADHD.

並列關鍵字

Attention-deficit/hyperactivity disorder ； neurofeedback ； attention ； hyperactivity/impulsivity ； brainwave ； Cz ； theta wave ； theta/beta power ratio

參考文獻

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